NPIMap

Organization Active NPI

Cullman Primary Care, PC

  • Clinical Medical Laboratory
  • Cullman, AL
National Provider Identifier
1982685178
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
01D0300133 Issued in AL
Legal business name
CULLMAN PRIMARY CARE, PC
Practice address
105 2ND Ave SE
Cullman, AL 35055-3511
Phone
(256) 734-3141
Fax
(256) 734-3866
NPI assigned
Nov 7, 2005
Last updated
Aug 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ben G Bostick, M.D.
Title
Supervising Physician
Phone
(256) 734-3141

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X
Clinical Medical Laboratory 291U00000X 01D0300133 AL Primary

Addresses

Primary practice location

105 2ND Ave SE
Cullman, AL 35055-3511

Mailing address

503 Clark St NE
Cullman, AL 35055-1921
Phone (256) 739-1759

Other identifiers 2

IdentifierTypeStateIssuer
000040933OtherALMEDICARE GROUP ID
000040933MedicaidAL

National Provider Directory

National Provider Directory

Locations

105 2nd Ave SE
Cullman, AL 35055
Phone (256) 734-3141

107 2nd Ave SE
Cullman, AL 35055
Phone (256) 739-4910

1800 AL Highway 157
Ste 101
Cullman, AL 35058
Phone (256) 255-1142

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1982685178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 CLARK ST NE",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350551921",
            "telephone_number": "256-739-1759",
            "fax_number": "256-739-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 2ND AVE SE",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350553511",
            "telephone_number": "256-734-3141",
            "fax_number": "256-734-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CULLMAN PRIMARY CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "BOSTICK",
        "authorized_official_first_name": "BEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SUPERVISING PHYSICIAN",
        "authorized_official_telephone_number": "256-734-3141",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AL",
            "license": "01D0300133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "000040933",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000040933",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cullman, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.