| Cooper Green Mercy Health Services Authority An Affiliate Of Uab | |
|
1515 6th Ave S Birmingham AL 35233-1601 | |
| (205) 930-3200 | |
| Not Available |
| Full Name | Cooper Green Mercy Health Services Authority An Affiliate Of Uab |
|---|---|
| Speciality | Clinic/Center |
| Location | 1515 6th Ave S, Birmingham, Alabama |
| Authorized Official Name and Position | Steve Payne (CFO) |
| Authorized Official Contact | 2059303200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cooper Green Mercy Health Services Authority An Affiliate Of Uab 1515 6th Ave S Birmingham AL 35233-1601 Ph: () - | Cooper Green Mercy Health Services Authority An Affiliate Of Uab 1515 6th Ave S Birmingham AL 35233-1601 Ph: (205) 930-3200 |
| NPI Number | 1366073108 |
|---|---|
| Provider Enumeration Date | 01/30/2020 |
| Last Update Date | 01/30/2020 |
| Medicare PECOS PAC ID | 0840629473 |
|---|---|
| Medicare Enrollment ID | O20200402003238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366073108 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
| Provider Name | Laura Hughes |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1598792178 PECOS PAC ID: 9335048990 Enrollment ID: I20040102000805 |
| Provider Name | Beverly A Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679715452 PECOS PAC ID: 1557264116 Enrollment ID: I20040130000252 |
| Provider Name | Delbert H Hahn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1700802261 PECOS PAC ID: 6002809639 Enrollment ID: I20040408000544 |
| Provider Name | Luis F Pineda |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1538125695 PECOS PAC ID: 6103716964 Enrollment ID: I20040420001189 |
| Provider Name | Caroline A Reich |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992700199 PECOS PAC ID: 4688579386 Enrollment ID: I20040521000493 |
| Provider Name | Arthur Dwight Sandy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083677173 PECOS PAC ID: 8123019494 Enrollment ID: I20040524001266 |
| Provider Name | Trevor Alden Lundstrom |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619930047 PECOS PAC ID: 3476538562 Enrollment ID: I20040622001501 |
| Provider Name | Gregory Dwain Jackson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104889070 PECOS PAC ID: 3779569892 Enrollment ID: I20040628001463 |
| Provider Name | Allen Benensohn Oser |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023071479 PECOS PAC ID: 0749266872 Enrollment ID: I20040628001574 |
| Provider Name | Harry Benjamin Rosenthal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477517944 PECOS PAC ID: 8426034521 Enrollment ID: I20040629000299 |
| Provider Name | Jill Arnita Rutherford |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497718860 PECOS PAC ID: 4385620483 Enrollment ID: I20040629000329 |
| Provider Name | Stuart Louis Siegal |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508829623 PECOS PAC ID: 3577549583 Enrollment ID: I20040629000482 |
| Provider Name | Edward A Sullivan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275596926 PECOS PAC ID: 3072599067 Enrollment ID: I20040629001044 |
| Provider Name | Robert Henry Thomas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588628275 PECOS PAC ID: 9537150891 Enrollment ID: I20040629001092 |
| Provider Name | Joy L Deupree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043095375 PECOS PAC ID: 7719953280 Enrollment ID: I20040907000419 |
| Provider Name | John W Retan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225104094 PECOS PAC ID: 0446200778 Enrollment ID: I20050308000729 |
| Provider Name | David D. Thornton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821052424 PECOS PAC ID: 4486608403 Enrollment ID: I20050311000354 |
| Provider Name | Michael Brant Ruff |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932162971 PECOS PAC ID: 2860446895 Enrollment ID: I20050311000437 |
| Provider Name | Francis S Massie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437183050 PECOS PAC ID: 4688616253 Enrollment ID: I20050524000658 |
| Provider Name | Mark A Fruendt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306164223 PECOS PAC ID: 5294778841 Enrollment ID: I20050628001349 |
| Provider Name | Mark W Kunkel |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1811925951 PECOS PAC ID: 4789612888 Enrollment ID: I20050729001034 |
| Provider Name | Polly Barlow |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326093881 PECOS PAC ID: 8426082488 Enrollment ID: I20050920000856 |
| Provider Name | Brunda Revanna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689646135 PECOS PAC ID: 7315967122 Enrollment ID: I20051122000810 |
| Provider Name | Carol A Leitner |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1942245428 PECOS PAC ID: 3173518859 Enrollment ID: I20060228000304 |
| Provider Name | Andrea L Cherrington |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467485029 PECOS PAC ID: 0941196612 Enrollment ID: I20061208000209 |
| Provider Name | Kelley Catron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922038751 PECOS PAC ID: 6608876339 Enrollment ID: I20070103000404 |
| Provider Name | Shane Adam Wear |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457497851 PECOS PAC ID: 1052412475 Enrollment ID: I20070728000135 |
| Provider Name | Cecil James Mccollum |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1295934016 PECOS PAC ID: 3274626072 Enrollment ID: I20070911000095 |
| Provider Name | Shankar Yalamanchili |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558332569 PECOS PAC ID: 0547343311 Enrollment ID: I20080218000110 |
| Provider Name | Clinton R Waggoner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1235344011 PECOS PAC ID: 4688745763 Enrollment ID: I20080617000525 |
| Provider Name | Russell W Read |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1770518474 PECOS PAC ID: 2668548066 Enrollment ID: I20080909000494 |
| Provider Name | Benjamin B Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932141041 PECOS PAC ID: 0749216216 Enrollment ID: I20081103000489 |
| Provider Name | Karen G Reynolds |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598832792 PECOS PAC ID: 9133160278 Enrollment ID: I20090106000172 |
| Provider Name | Debbie Hamby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770621872 PECOS PAC ID: 6800987082 Enrollment ID: I20090223000367 |
| Provider Name | Steven M Pogwizd |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1730293093 PECOS PAC ID: 8022028018 Enrollment ID: I20090513000213 |
| Provider Name | Shirin Banu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295828010 PECOS PAC ID: 4981753613 Enrollment ID: I20090528000430 |
| Provider Name | Alethia Sellers |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1154543197 PECOS PAC ID: 3072665330 Enrollment ID: I20090716000625 |
| Provider Name | Mary A Hess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265660146 PECOS PAC ID: 4284789959 Enrollment ID: I20090901000429 |
| Provider Name | David N Simmons |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1124278379 PECOS PAC ID: 4688716814 Enrollment ID: I20100126000366 |
| Provider Name | Wilkes Petrey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861673881 PECOS PAC ID: 9234281932 Enrollment ID: I20100708000552 |
| Provider Name | Jonathan Wesley Walter |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952515942 PECOS PAC ID: 3072645878 Enrollment ID: I20100714000449 |
| Provider Name | Rebecca B Kissel |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1417984972 PECOS PAC ID: 1052435716 Enrollment ID: I20100901000673 |
| Provider Name | William Elhannon Somerall |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1780683011 PECOS PAC ID: 8527182211 Enrollment ID: I20100902000017 |
| Provider Name | Richard V Sims |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1336160761 PECOS PAC ID: 4981728581 Enrollment ID: I20100903000372 |
| Provider Name | Bhupesh Panwar |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1093997967 PECOS PAC ID: 6305032327 Enrollment ID: I20101201001365 |
| Provider Name | Lanning B Kline |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1841227477 PECOS PAC ID: 1850285040 Enrollment ID: I20101217000388 |
| Provider Name | Susanne Fogger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013913805 PECOS PAC ID: 9638355399 Enrollment ID: I20110512000894 |
| Provider Name | Khurram Bashir |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770538233 PECOS PAC ID: 8224200472 Enrollment ID: I20111011000718 |
| Provider Name | Brandon Brooks |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1962455204 PECOS PAC ID: 0749293306 Enrollment ID: I20120206000525 |
| Provider Name | Enos C Ngetich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396019188 PECOS PAC ID: 6800057001 Enrollment ID: I20120416000493 |
| Provider Name | Barrett P Cary |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497958581 PECOS PAC ID: 3375707995 Enrollment ID: I20120612000306 |
| Provider Name | Julia Morris |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699956623 PECOS PAC ID: 6709042971 Enrollment ID: I20120717000342 |
| Provider Name | Garima Agarwal |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1578821864 PECOS PAC ID: 1557517299 Enrollment ID: I20120810000726 |
| Provider Name | Kimberly Cornelius-peace |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134341019 PECOS PAC ID: 9335225432 Enrollment ID: I20121107000549 |
| Provider Name | Ellen Barton Blackmon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972723179 PECOS PAC ID: 2769633825 Enrollment ID: I20121119000506 |
| Provider Name | Huichuan G Lin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205800471 PECOS PAC ID: 7517111461 Enrollment ID: I20130131000336 |
| Provider Name | Deepti Bahl |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1003098070 PECOS PAC ID: 8224283015 Enrollment ID: I20130228000133 |
| Provider Name | Robert Hines |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396900197 PECOS PAC ID: 7719125624 Enrollment ID: I20130605000540 |
| Provider Name | Jayakrishna Madabushi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982836045 PECOS PAC ID: 5092956599 Enrollment ID: I20130725000726 |
| Provider Name | Mathieu Nader |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306003579 PECOS PAC ID: 2062652233 Enrollment ID: I20131216000241 |
| Provider Name | Eric K Judd |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1972706067 PECOS PAC ID: 3375766587 Enrollment ID: I20140515000976 |
| Provider Name | Rhodemarie Maron |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1699982488 PECOS PAC ID: 1759449721 Enrollment ID: I20140805001766 |
| Provider Name | Shruti P Agnihotri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1699973669 PECOS PAC ID: 0042487274 Enrollment ID: I20141016002617 |
| Provider Name | Tiffany T Mayo |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1043572191 PECOS PAC ID: 4284874058 Enrollment ID: I20141024001306 |
| Provider Name | Kimberly Boackle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174924880 PECOS PAC ID: 1456673508 Enrollment ID: I20141201001650 |
| Provider Name | Stephanie Denham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073831806 PECOS PAC ID: 0143466284 Enrollment ID: I20150617002735 |
| Provider Name | Timothy Carpenter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215008297 PECOS PAC ID: 3870638349 Enrollment ID: I20150708002060 |
| Provider Name | Rebekah Weil |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255698304 PECOS PAC ID: 4688824469 Enrollment ID: I20150723008541 |
| Provider Name | Prentiss Albert Lawson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1851544258 PECOS PAC ID: 5890932115 Enrollment ID: I20150730011038 |
| Provider Name | Raegan Durant |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073561262 PECOS PAC ID: 3072403104 Enrollment ID: I20150924000833 |
| Provider Name | Stephanie H. Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316336092 PECOS PAC ID: 8325358971 Enrollment ID: I20151110002734 |
| Provider Name | Shawn D Tolbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508164377 PECOS PAC ID: 4284818873 Enrollment ID: I20151207001267 |
| Provider Name | Mary C Kipchumba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205292984 PECOS PAC ID: 9133426232 Enrollment ID: I20160404001329 |
| Provider Name | Kyle D Wood |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1942595350 PECOS PAC ID: 4284934407 Enrollment ID: I20160606001023 |
| Provider Name | Nicholas Hoppmann |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1912342981 PECOS PAC ID: 6002107299 Enrollment ID: I20160617001595 |
| Provider Name | Stephen Clarkson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1740626027 PECOS PAC ID: 9335381847 Enrollment ID: I20160620000377 |
| Provider Name | Anand S Iyer |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1104116417 PECOS PAC ID: 1355589912 Enrollment ID: I20170706002328 |
| Provider Name | Abhinav Agarwal |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1043461445 PECOS PAC ID: 3375819303 Enrollment ID: I20171019000550 |
| Provider Name | Sounick Haldar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578906939 PECOS PAC ID: 5597996520 Enrollment ID: I20171207002203 |
| Provider Name | Elizabeth Allen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1689019523 PECOS PAC ID: 6608000815 Enrollment ID: I20180627002063 |
| Provider Name | Brent Donovan Haverstock |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1780111831 PECOS PAC ID: 6709159841 Enrollment ID: I20180920002292 |
| Provider Name | Raegan Rogers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316436504 PECOS PAC ID: 1052663002 Enrollment ID: I20181003000455 |
| Provider Name | Julianna J Coleman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831502970 PECOS PAC ID: 4082935986 Enrollment ID: I20181031002425 |
| Provider Name | Patricia Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750856324 PECOS PAC ID: 7113263989 Enrollment ID: I20190115003449 |
| Provider Name | Tokeysha Johnson Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316191968 PECOS PAC ID: 8224370507 Enrollment ID: I20190507002155 |
| Provider Name | Haley Routh Clark |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598109597 PECOS PAC ID: 0446505457 Enrollment ID: I20190520002275 |
| Provider Name | Laura S Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1588009104 PECOS PAC ID: 0446484836 Enrollment ID: I20190722003196 |
| Provider Name | Kenneth John Unger |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1558918748 PECOS PAC ID: 9739411018 Enrollment ID: I20191106001886 |
| Provider Name | Timothy Thomas Ramsey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265540561 PECOS PAC ID: 6800898388 Enrollment ID: I20191116000151 |
| Provider Name | Frederick William Ernst |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1407140304 PECOS PAC ID: 3072947142 Enrollment ID: I20191223002197 |
| Provider Name | Sumayah Abed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902346802 PECOS PAC ID: 5395175608 Enrollment ID: I20200428000531 |
| Provider Name | Christina Nadar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356630719 PECOS PAC ID: 8921227620 Enrollment ID: I20200511002178 |
| Provider Name | Peggy Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023426244 PECOS PAC ID: 2769813278 Enrollment ID: I20200518002233 |
| Provider Name | Brittany Hermecz |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376922963 PECOS PAC ID: 5294022018 Enrollment ID: I20200604000656 |
| Provider Name | Jamonica Montrese Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821619164 PECOS PAC ID: 1052721743 Enrollment ID: I20201109002157 |
| Provider Name | Deonna B Dodd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376962092 PECOS PAC ID: 7618270299 Enrollment ID: I20201221001667 |
| Provider Name | Yulia Khodneva |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477907343 PECOS PAC ID: 9133402134 Enrollment ID: I20210202000466 |
| Provider Name | Erfan M Karim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316472863 PECOS PAC ID: 0648545160 Enrollment ID: I20210316001328 |
| Provider Name | Daniel Barton Booth |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1982051223 PECOS PAC ID: 2466738612 Enrollment ID: I20210511002083 |
| Provider Name | Chung Ah Kim West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619439619 PECOS PAC ID: 6103235551 Enrollment ID: I20210514001147 |
| Provider Name | Daniel Bergman |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1053843169 PECOS PAC ID: 4587933510 Enrollment ID: I20210608000666 |
| Provider Name | Bailey Lipham |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1396130449 PECOS PAC ID: 2062761372 Enrollment ID: I20210722002320 |
| Provider Name | Lindsey Shipley |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1477059830 PECOS PAC ID: 6608121611 Enrollment ID: I20210813000700 |
| Provider Name | Thomas B Evely |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1205217577 PECOS PAC ID: 4183021926 Enrollment ID: I20210922000688 |
| Provider Name | Yan Lu |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1275997165 PECOS PAC ID: 0749575710 Enrollment ID: I20210922001344 |
| Provider Name | Elizabeth Ellis Kenemer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568715050 PECOS PAC ID: 5597917906 Enrollment ID: I20211020002135 |
| Provider Name | Warren Lee Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245574821 PECOS PAC ID: 9638321227 Enrollment ID: I20211117001102 |
| Provider Name | Anderson Scott Marshall |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144752544 PECOS PAC ID: 4880971563 Enrollment ID: I20211118001629 |
| Provider Name | James Coleman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881891786 PECOS PAC ID: 2365523529 Enrollment ID: I20220204001125 |
| Provider Name | Amanda Gail Sandlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659029312 PECOS PAC ID: 4486049780 Enrollment ID: I20220324000148 |
| Provider Name | Kelsey E Poisson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1790218188 PECOS PAC ID: 3678952751 Enrollment ID: I20220621000399 |
| Provider Name | Steven A Bria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215672308 PECOS PAC ID: 4981083524 Enrollment ID: I20220628001367 |
| Provider Name | Justin T Watts |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801329149 PECOS PAC ID: 2466726385 Enrollment ID: I20220711001025 |
| Provider Name | Gabrielle Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912595349 PECOS PAC ID: 9830570712 Enrollment ID: I20220725000205 |
| Provider Name | Minakshi Vivek Shukla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952864613 PECOS PAC ID: 3678954476 Enrollment ID: I20220725001641 |
| Provider Name | Jose Rubio Mosquera |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1174907984 PECOS PAC ID: 9739412354 Enrollment ID: I20220726003336 |
| Provider Name | Ghaida K Zaid |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225523210 PECOS PAC ID: 7113274846 Enrollment ID: I20220727001709 |
| Provider Name | Rebeka Sipma |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215434303 PECOS PAC ID: 6901288109 Enrollment ID: I20220804002312 |
| Provider Name | Sierra Shanel Ellis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790158467 PECOS PAC ID: 0749668077 Enrollment ID: I20220809002334 |
| Provider Name | Patricia Ajayi-fox |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1790166221 PECOS PAC ID: 6800298217 Enrollment ID: I20220815000982 |
| Provider Name | Rouhin Sen |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1811370802 PECOS PAC ID: 3375825839 Enrollment ID: I20220904000026 |
| Provider Name | Steven William Fox |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1497134357 PECOS PAC ID: 7113232042 Enrollment ID: I20221007000000 |
| Provider Name | Sandrea Comeneka Lawler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932816394 PECOS PAC ID: 3173992286 Enrollment ID: I20221213000885 |
| Provider Name | Eileen Rife |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1174917520 PECOS PAC ID: 4183915762 Enrollment ID: I20221228001760 |
| Provider Name | Ambreia D Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619572062 PECOS PAC ID: 6406227719 Enrollment ID: I20230125000346 |
| Provider Name | Allen Nawrocki |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740600345 PECOS PAC ID: 6305276817 Enrollment ID: I20230329002007 |
| Provider Name | Jeffrey R. Black |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336646629 PECOS PAC ID: 5496097669 Enrollment ID: I20230516001145 |
| Provider Name | Evan Todd Blair |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518455476 PECOS PAC ID: 0941559033 Enrollment ID: I20230517002879 |
| Provider Name | James Paul Cook |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477050235 PECOS PAC ID: 7214261783 Enrollment ID: I20230616001532 |
| Provider Name | Maithreyi Chappidi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1710474473 PECOS PAC ID: 2961862578 Enrollment ID: I20230714000368 |
| Provider Name | Mitali Sen |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1386029262 PECOS PAC ID: 1052660636 Enrollment ID: I20230721001981 |
| Provider Name | Christina Cole Mills |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548723760 PECOS PAC ID: 8022341486 Enrollment ID: I20230802003142 |
| Provider Name | Mariana Urquiaga Changanaqui |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1366949679 PECOS PAC ID: 3678934957 Enrollment ID: I20230802003685 |
| Provider Name | Samina Karim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619592979 PECOS PAC ID: 7416310941 Enrollment ID: I20230830002885 |
| Provider Name | Landen Marshall Tharp |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1316434806 PECOS PAC ID: 8527316959 Enrollment ID: I20230906002048 |
| Provider Name | Raeann L Whitney |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1558983304 PECOS PAC ID: 3072977149 Enrollment ID: I20230908000992 |
| Provider Name | Elizabeth Anne Terry |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1104310259 PECOS PAC ID: 1456754514 Enrollment ID: I20230911003535 |
| Provider Name | Rajkumar Selvanayagam |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265166508 PECOS PAC ID: 8729432026 Enrollment ID: I20230920001537 |
| Provider Name | Hassan Alhussein |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588141857 PECOS PAC ID: 4082958590 Enrollment ID: I20230926002173 |
| Provider Name | Matthew Robinson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710481783 PECOS PAC ID: 0648523605 Enrollment ID: I20230927000108 |
| Provider Name | Prerana R Rodrigues |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710507611 PECOS PAC ID: 1355795162 Enrollment ID: I20230928000037 |
| Provider Name | Frederick Albert Kebbel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457730186 PECOS PAC ID: 4789009895 Enrollment ID: I20230928000753 |
| Provider Name | Carolina Temple Parker |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326501651 PECOS PAC ID: 8224483730 Enrollment ID: I20231018000759 |
Lifestyle Management Of Birmingham, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10 Old Montgomery Hwy, Suite 100, Birmingham, AL 35209 Phone: 205-949-1900 Fax: 205-949-1919 | |
Protective Life Bhs Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2801 Us 280, Birmingham, AL 35223 Phone: 205-268-3265 | |
Inverness Family Medicine Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4902 Valleydale Rd, Birmingham, AL 35242 Phone: 205-980-8099 Fax: 205-980-2606 | |
Hoover Alt Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3421 S Shades Crest Rd, Birmingham, AL 35244 Phone: 205-936-2203 | |
Birmingham Clinics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1608 13th Ave S, 200, Birmingham, AL 35205 Phone: 205-918-7120 | |
Tom Tartt Brown, Jr., M.d. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2660 10th Ave S, Ste 225, Birmingham, AL 35205 Phone: 205-933-5808 Fax: 205-930-2119 | |
Taylor Consulting, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3800 Ridgeway Dr, Birmingham, AL 35209 Phone: 205-447-0703 |