NORTHSIDE MEDICAL, INC.
NPI 1205089372
Clinic/Center - Primary Care in Fort Payne, AL
About Northside Medical, Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
NORTHSIDE MEDICAL, INC. (NPI 1205089372) is a healthcare organization registered as a primary care in Fort Payne, Alabama and active in the NPI registry since November 2008. The organization holds a CLIA Waiver certificate valid through September 16, 2027 and lists Robert W. Theakston, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Northside Medical, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Northside Medical, Inc., which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 01D1105179
Northside Medical Inc · Fort Payne, ALFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Northside Medical, Inc.'s NPI number?
The NPI number for Northside Medical, Inc. is 1205089372. It was assigned to this organization in the NPPES registry on November 2, 2008.
Where is Northside Medical, Inc. located?
Northside Medical, Inc. is located at 211 Greenhill Blvd NW, Fort Payne, AL 35967. The listed phone number is (256) 845-9355.
What is Northside Medical, Inc.'s specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Northside Medical, Inc. enrolled in Medicare?
Yes. Northside Medical, Inc. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Northside Medical, Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to Northside Medical, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Northside Medical, Inc. hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 01D1105179) is associated with this NPI, valid through September 16, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Northside Medical, Inc. was last updated on November 2, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Northside Medical, Inc. · NPI 1205089372
Primary Care organization in Fort Payne, Alabama. Organization record, active in the CMS NPPES registry since November 2, 2008.
## Identity
- **NPI:** 1205089372 (Entity type: Organization)
- **Enumerated:** November 2, 2008
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Robert Theakston, PRESIDENT
## Practice location
- **Address:** 211 GREENHILL BLVD NW, Fort Payne, AL 35967-3755
- **Phone:** (256) 845-9355
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (General Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 2, 2008
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1205089372) · Data from the CMS NPPES public registry.