NPIMap

Organization Active NPI

University of South Alabama

  • Family Medicine Physician
  • Mobile, AL
National Provider Identifier
1992746838
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNIVERSITY OF SOUTH ALABAMA
Practice address
5870 Alumni Cir
Mobile, AL 36688-0001
Phone
(251) 460-7151
Fax
(251) 414-8227
NPI assigned
Jun 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

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

Authorized official

Name
Beverly Kellen
Title
Practice Director
Phone
(251) 460-7681

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

5870 Alumni Cir
Mobile, AL 36688-0001

Mailing address

5870 Alumni Cir
Mobile, AL 36688-0001
Phone (251) 460-7151

Other identifiers 2

IdentifierTypeStateIssuer
529928530MedicaidAL
W531OtherALBCBS

Other names 1

  • USA Student Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115000773 AL Part B Supplier - Clinic/Group Practice 3072425149 Receives reassigned benefits from 418 practitioners
4 other NPIs on this enrollment
Practice locations: Mobile, AL; Monroeville, AL; Fairhope, AL; Jackson, AL

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

5870 Usa S Dr
Mobile, AL 36688
Phone (251) 460-7151

5870 Alumni Cir
Mobile, AL 36688
Phone (251) 460-7151

1504 Spring Hill Ave
Mobile, AL 36604
Phone (251) 219-3900

1504 Spring Hill Ave
Ste 1722
Mobile, AL 36604
Phone (251) 405-5326

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
USA Health Providence HospitalMobile, AL, CCN 010090 Hospital 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners 450

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 450

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471910400000",
    "number": "1992746838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5870 ALUMNI CIR",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366880001",
            "telephone_number": "251-460-7151",
            "fax_number": "251-414-8227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5870 ALUMNI CIR",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366880001",
            "telephone_number": "251-460-7151",
            "fax_number": "251-414-8227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF SOUTH ALABAMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2016-08-23",
        "status": "A",
        "authorized_official_last_name": "KELLEN",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "PRACTICE DIRECTOR",
        "authorized_official_telephone_number": "251-460-7681"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529928530",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "W531",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "USA Student Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.