Southern Divine Family Medical Center Llc - Medicare Primary Care in Altoona, AL

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Southern Divine Family Medical Center Llc is a medicare enrolled primary clinic (Internal Medicine) in Altoona, Alabama. The current practice location for Southern Divine Family Medical Center Llc is 7130 6th Ave, Altoona, Alabama. For appointments, you can reach them via phone at (205) 589-1092. The mailing address for Southern Divine Family Medical Center Llc is Po Box 35, Altoona, Alabama and phone number is (205) 589-1092.

Southern Divine Family Medical Center Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1104456920. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (205) 589-1092.

Contact Information

Southern Divine Family Medical Center Llc
7130 6th Ave
Altoona
AL 35952-9052
(205) 589-1092
(205) 589-1096

Map and Direction


Primary Care Clinic Profile

Full NameSouthern Divine Family Medical Center Llc
SpecialityInternal Medicine
Location7130 6th Ave, Altoona, Alabama
Authorized Official Name and PositionEnrico D Gaspar (OWNER)
Authorized Official Contact2568408181
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Southern Divine Family Medical Center Llc
Po Box 35
Altoona
AL 35952-0035

Ph: (205) 589-1092		Southern Divine Family Medical Center Llc
7130 6th Ave
Altoona
AL 35952-9052

Ph: (205) 589-1092

NPI Details:

NPI Number1104456920
Provider Enumeration Date01/21/2020
Last Update Date04/09/2022

Medicare PECOS Information:

Medicare PECOS PAC ID0648692582
Medicare Enrollment IDO20200622002415

Medical Identifiers

Medical identifiers for Southern Divine Family Medical Center Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1104456920NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207R00000XInternal Medicine (* (Not Available))Primary
363LA2100XNurse Practitioner - Acute Care (* (Not Available))Secondary
363LA2200XNurse Practitioner - Adult Health (* (Not Available))Secondary
363LF0000XNurse Practitioner - Family (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Southern Divine Family Medical Center Llc acts as a billing entity for following providers:
Provider NameWilliam L Gibson
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1083609606
PECOS PAC ID: 5991608457
Enrollment ID: I20040130000915
Provider NameEnrico Deseo Y. Gaspar
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1497740492
PECOS PAC ID: 6709849649
Enrollment ID: I20041110001234
Provider NameAlvin V Tenchavez
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1225023211
PECOS PAC ID: 5294865895
Enrollment ID: I20100608000628
Provider NameAshley C Lackey
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1679847487
PECOS PAC ID: 3476714676
Enrollment ID: I20120416000461
Provider NamePatrick J Sellers
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1205342268
PECOS PAC ID: 0345597761
Enrollment ID: I20180828002715
Provider NameCody E Jarmon
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1497230478
PECOS PAC ID: 1456693498
Enrollment ID: I20190423002698
Provider NameBethany L Tucker
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1881368934
PECOS PAC ID: 8820493067
Enrollment ID: I20210825003212
Provider NameBranden Sims
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1972265973
PECOS PAC ID: 6709276561
Enrollment ID: I20211209001896
Provider NameEthan Caleb Bonds
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1154082758
PECOS PAC ID: 2769877505
Enrollment ID: I20220315000743
Provider NameKayla Winfrey
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1467173864
PECOS PAC ID: 0345617379
Enrollment ID: I20221104000960
Provider NameJoni Kelley
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1851023543
PECOS PAC ID: 0840662797
Enrollment ID: I20230202001879
Provider NameAmanda Mccormick Willis
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1508559956
PECOS PAC ID: 7618330499
Enrollment ID: I20230825003039
Provider NameAshley Brooke Bozarth
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1184439184
PECOS PAC ID: 7810413242
Enrollment ID: I20250429002612

Reviews and Comments


Internal Medicine in Altoona, AL

Agape Medicine Llc
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 42598 State Highway 75, Altoona, AL 35952
Phone: 205-466-9096    Fax: 205-466-9053

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.