| River Region Family Medicine, Llc | |
|
277 Huntress Street Suite 100 Wetumpka AL 36092 | |
| (334) 567-4311 | |
| Not Available |
| Full Name | River Region Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 277 Huntress Street, Wetumpka, Alabama |
| Authorized Official Name and Position | Michael D Bruce (CEO) |
| Authorized Official Contact | 2566750412 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River Region Family Medicine, Llc Po Box 130 Wetumpka AL 36092-0003 Ph: (334) 567-4311 | River Region Family Medicine, Llc 277 Huntress Street Suite 100 Wetumpka AL 36092 Ph: (334) 567-4311 |
| NPI Number | 1578195525 |
|---|---|
| Provider Enumeration Date | 02/07/2020 |
| Last Update Date | 08/20/2020 |
| Medicare PECOS PAC ID | 2163853151 |
|---|---|
| Medicare Enrollment ID | O20200506002757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578195525 | NPI | - | NPPES |
| 120559 | Medicaid | AL | |
| APPLIED | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Colin C Stewart |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093710832 PECOS PAC ID: 1456341858 Enrollment ID: I20040517001137 |
| Provider Name | Bibb Allen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538164785 PECOS PAC ID: 7810801545 Enrollment ID: I20050314000838 |
| Provider Name | Todd C Brightbill |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619972874 PECOS PAC ID: 9537073168 Enrollment ID: I20050314000914 |
| Provider Name | Matthew Larrison |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881659407 PECOS PAC ID: 8729099494 Enrollment ID: I20060509000504 |
| Provider Name | Joel Mixon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043261969 PECOS PAC ID: 5496767782 Enrollment ID: I20060705000275 |
| Provider Name | Jeana Ann Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811206386 PECOS PAC ID: 8123216645 Enrollment ID: I20101228000956 |
| Provider Name | Spencer Coleman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629011770 PECOS PAC ID: 3375714421 Enrollment ID: I20110921000187 |
| Provider Name | Martin A Lyons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356640379 PECOS PAC ID: 8325213226 Enrollment ID: I20111205000275 |
| Provider Name | Mary B Labriola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124387659 PECOS PAC ID: 0941464309 Enrollment ID: I20120614000579 |
| Provider Name | Julia Morris |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699956623 PECOS PAC ID: 6709042971 Enrollment ID: I20120717000342 |
| Provider Name | Brandy T Laurenzi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609178714 PECOS PAC ID: 2668619792 Enrollment ID: I20130509000490 |
| Provider Name | Mathieu Nader |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306003579 PECOS PAC ID: 2062652233 Enrollment ID: I20131216000241 |
| Provider Name | Manish Y Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205070851 PECOS PAC ID: 5991944068 Enrollment ID: I20140503000026 |
| Provider Name | Maximilian Pyko |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477782969 PECOS PAC ID: 0648585810 Enrollment ID: I20150817002431 |
| Provider Name | Daniel James Israel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568721991 PECOS PAC ID: 0143464412 Enrollment ID: I20170831002922 |
| Provider Name | Desmin Milner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740549187 PECOS PAC ID: 5294975975 Enrollment ID: I20170908002264 |
| Provider Name | Jeffrey Stevens |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164868212 PECOS PAC ID: 6608157664 Enrollment ID: I20180724001673 |
| Provider Name | Darcy P Blankenship |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881176964 PECOS PAC ID: 8224467451 Enrollment ID: I20200408004561 |
| Provider Name | Nathan R Hewlett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770927287 PECOS PAC ID: 6406184449 Enrollment ID: I20200519001010 |
| Provider Name | Chad Cox |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518385384 PECOS PAC ID: 5597096776 Enrollment ID: I20200618003156 |
| Provider Name | Brent Jordan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194107839 PECOS PAC ID: 6709204639 Enrollment ID: I20220802001973 |
| Provider Name | Haley B Pemberton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770268138 PECOS PAC ID: 7416303664 Enrollment ID: I20231025001191 |
| Provider Name | Justin Owens |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457858698 PECOS PAC ID: 0244691210 Enrollment ID: I20240617004064 |
| Provider Name | Jon Mather |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932465812 PECOS PAC ID: 9436424405 Enrollment ID: I20250122000192 |
| Provider Name | Shankar Iyer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568027860 PECOS PAC ID: 3476070129 Enrollment ID: I20250507000567 |
| Provider Name | Dana Bonaminio |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659606788 PECOS PAC ID: 9032355870 Enrollment ID: I20250512000767 |
| Provider Name | Stephen Cole |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740609684 PECOS PAC ID: 5890098180 Enrollment ID: I20250513000780 |
| Provider Name | Lee Rogers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720286487 PECOS PAC ID: 1456443787 Enrollment ID: I20250513002439 |
| Provider Name | Alyson Singh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770945966 PECOS PAC ID: 8820497704 Enrollment ID: I20250513003197 |
| Provider Name | Paul Yager |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790305282 PECOS PAC ID: 8921526963 Enrollment ID: I20250514001238 |
| Provider Name | Gabriel Starace |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992960298 PECOS PAC ID: 1052557907 Enrollment ID: I20250514001881 |
| Provider Name | Steven Shaba |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396909255 PECOS PAC ID: 4284804022 Enrollment ID: I20250514003184 |
| Provider Name | Vineet Sharma |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508804337 PECOS PAC ID: 5597710863 Enrollment ID: I20250516000091 |
| Provider Name | Leomar Bautista |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477930337 PECOS PAC ID: 0042632226 Enrollment ID: I20250516002322 |
| Provider Name | Jeffrey Michael Huggett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447299698 PECOS PAC ID: 5092618256 Enrollment ID: I20250519003067 |
| Provider Name | Timothy Carter |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053369413 PECOS PAC ID: 2062422611 Enrollment ID: I20250520004673 |
| Provider Name | Stephen Fisher |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184990574 PECOS PAC ID: 9830466101 Enrollment ID: I20250520004944 |
| Provider Name | Michael C Cian |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902845118 PECOS PAC ID: 7810899499 Enrollment ID: I20250521003530 |
| Provider Name | Lauren Gates |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811343015 PECOS PAC ID: 5799078879 Enrollment ID: I20250530000406 |
| Provider Name | Viraj K Parikh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134321235 PECOS PAC ID: 5496895898 Enrollment ID: I20250611001098 |
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