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MTN LAKE UROLOGY PC
NPI 1801050364
Specialist in Scottsboro, AL

Active since July 14, 2008CLIA 01D2123209 · Microscopy
750 BYRON RD, SCOTTSBORO, AL 35769(256) 259-8765(256) 716-8060 Get Directions Write a Review

NPPES record last updated: March 21, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mtn Lake Urology Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MTN LAKE UROLOGY PC (NPI 1801050364) is a healthcare organization registered as a specialist in Scottsboro, Alabama and active in the NPI registry since July 2008. The organization holds a CLIA Microscopy certificate valid through December 13, 2026 and lists Sherry Gross, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1801050364
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameMTN LAKE UROLOGY PC
Location Address750 BYRON RDScottsboro, AL 35769-4051
Mailing Address750 Byron RdScottsboro, AL 35769-4051 · (256) 259-8765 · Fax (256) 716-8060
Phone(256) 259-8765
Fax(256) 716-8060
Organization SubpartNo
Authorized OfficialSherry GrossOffice Manager · (256) 259-8765
Enumeration DateJuly 14, 2008
Last NPPES UpdateMarch 21, 2018
✔ NPI 1801050364 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in AL · 17993
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
750 BYRON RD, Scottsboro, AL 35769
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Other Identifiers 1

Medicaid106277AL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mtn Lake Urology Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Mtn Lake Urology PC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Kerry Walker, CRNP
Nurse Practitioner
NPI 1427945476
750 BYRON RD
Scottsboro, AL 35769
(256) 259-8765
✔ PECOS✔ Accepts MedicareSame address
Michael Simmons, MD
Urology
NPI 1225023344
743 SPRING ST NE
Gainesville, GA 30501
(770) 219-8430
✔ PECOS✔ Accepts Medicare128 mi

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 for Provider-Performed Microscopy Procedures (PPMP) 01D2123209

Mtn Lake Urology PC · Scottsboro, AL
Active · expires Dec 13, 2026
CLIA Number01D2123209
Laboratory TypePhysician Office
Certificate Effective DateDecember 14, 2024
Certificate Expiration DateDecember 13, 2026
Laboratory DirectorMichael G. Simmons MD
Laboratory Phone(256) 259-8765
Laboratory LocationMtn Lake Urology PC750 Byron Road, Scottsboro, AL 35769
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently 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 Mtn Lake Urology PC's NPI number?

The NPI number for Mtn Lake Urology PC is 1801050364. It was assigned to this organization in the NPPES registry on July 14, 2008.

Where is Mtn Lake Urology PC located?

Mtn Lake Urology PC is located at 750 Byron Rd, Scottsboro, AL 35769. The listed phone number is (256) 259-8765.

What is Mtn Lake Urology PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Mtn Lake Urology PC enrolled in Medicare?

Yes. Mtn Lake Urology PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mtn Lake Urology PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Mtn Lake Urology PC, in Nurse Practitioner and Urology. 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. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mtn Lake Urology PC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 01D2123209) is associated with this NPI, valid through December 13, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mtn Lake Urology PC was last updated on March 21, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.