| Details | Last Recertification Date | Update | Recertification | 1/31/2024 8:44:14 PM | 2/11/2025 2:51:13 PM | 2/11/2025 2:51 PM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2023 9:40:46 AM | 1/31/2024 8:44:14 PM | 1/31/2024 8:44 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2022 3:33:46 PM | 2/7/2023 9:40:46 AM | 2/7/2023 9:40 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/17/2023 5:07 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 630000016 | 1/17/2023 5:07 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | AL | 1/17/2023 5:07 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/17/2023 5:07 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 168720 | 1/17/2023 5:07 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | AL | 1/17/2023 5:07 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1417025917 | 1/17/2023 5:07 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | AL | 1/17/2023 5:07 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1699179440 | 1/17/2023 5:07 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | AL | 1/17/2023 5:07 PM |
| Contacts | Authorizing Official | Update | Group Change Request | Allen, Nanette
Interim CEO
Alabama Regional Medical Services
2054076913 | Greer, Thomas
CEO
Alabama Regional Medical Services
2054076951 | 1/12/2023 6:27 AM |
| Contacts | Authorizing Official | Update | Change Request | Gardner, Anthony
CEO
Alabama Regional Medical Services
2052125653 | Allen, Nanette
Interim CEO
Alabama Regional Medical Services
2054076913 | 4/11/2022 3:58 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Foster, Therersa
Compliance Officer
Alabama Regional Medical Services
2054076952 | Foster, Theresa
Compliance Officer
Alabama Regional Medical Services
2054076952 | 3/17/2022 9:29 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 11:12:30 AM | 2/3/2022 3:33:46 PM | 2/3/2022 3:33 PM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 11:22:32 AM | 2/3/2021 11:12:30 AM | 2/3/2021 11:12 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Foster, Therersa
Compliance Officer
Alabama Regional Medical Services
2054079681 | Foster, Therersa
Compliance Officer
Alabama Regional Medical Services
2054076952 | 7/13/2020 12:24 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2019 12:17:18 PM | 1/28/2020 11:22:32 AM | 1/28/2020 11:22 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Foster, Therersa
Compliance Officer
Alabama Regional Medical Services
2054075600-5681 | Foster, Therersa
Compliance Officer
Alabama Regional Medical Services
2054079681 | 8/28/2019 11:05 AM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2018 9:32:55 AM | 2/1/2019 12:17:18 PM | 2/1/2019 12:17 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Foster, Therersa
Compliance Officer
Alabama Regional Medical Services
2052125681 | Foster, Therersa
Compliance Officer
Alabama Regional Medical Services
2054075600-5681 | 7/9/2018 10:05 AM |
| Addresses | Billing Address | Update | Change Request | Birmingham Health Care
PO Box 11523
Birmingham, AL 35202 | ALABAMA REGIONAL MEDICAL SERVICES
PO Box 11526
Birmingham, AL 35202 | 3/29/2018 8:12 PM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2017 12:00:00 AM | 2/12/2018 9:32:55 AM | 2/12/2018 9:32 AM |
| Contacts | Primary Contact | Update | Change Request | Foster, Theresa
Compliance Officer
2054397215 | Foster, Therersa
Compliance Officer
Alabama Regional Medical Services
2052125681 | 10/20/2017 10:26 AM |
| Contacts | Authorizing Official | Update | Change Request | Gardner, Anthony
CEO
2052125653 | Gardner, Anthony
CEO
Alabama Regional Medical Services
2052125653 | 10/20/2017 10:26 AM |
| Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 10/20/2017 10:26 AM |
| Contacts | Signed By | Insert | | | LACEY, JIMMY
EXECUTIVE DIRECTOR
2052125653 | 2/10/2017 7:31 PM |
| Addresses | Main Address | Insert | | |
417 19TH STREET ENSLEY
BIRMINGHAM, AL 35218-1601 | 1/28/2017 12:58 PM |
| Contacts | Primary Contact | Insert | | | Foster, Theresa
Compliance Officer
2054397215 | 1/28/2017 12:58 PM |
| Contacts | Authorizing Official | Update | | Osborne, Patricia
CEO
2052125622 | Gardner, Anthony
CEO
2052125653 | 1/28/2017 12:58 PM |
| Details | Last Recertification Date | Update | | 3/7/2016 12:00:00 AM | 1/28/2017 12:00:00 AM | 1/28/2017 12:58 PM |
| Addresses | Billing Address | Insert | | | Birmingham Health Care
PO Box 11523
Birmingham, AL 35202 | 11/22/2016 7:17 AM |
| Contacts | Authorizing Official | Insert | | | Osborne, Patricia
CEO
2052125622 | 7/28/2016 3:58 PM |
| Details | Entity Name | Update | | BIRMINGHAM HEALTH CARE INC | ALABAMA REGIONAL MEDICAL SERVICES | 7/28/2016 3:57 PM |
| Details | Last Recertification Date | Update | | | 3/7/2016 12:00:00 AM | 3/7/2016 8:54 AM |
| Dates | Participating Approval Date | Update | | | 1/28/2015 12:00:00 AM | 1/28/2015 4:09 PM |
| Details | State | Update | | Pending | Active | 1/28/2015 4:09 PM |
| Dates | Start Date | Update | | | 4/1/2015 12:00:00 AM | 1/28/2015 4:09 PM |
| Details | 340B ID | Update | | ONLINE_REG_49828 | CH04196V | 1/20/2015 1:32 PM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_49828 | 1/15/2015 2:10 PM |
| Details | Last Recertification Date | Insert | | | | 1/15/2015 2:10 PM |
| Details | Grant Number | Insert | | | H80CS00020 | 1/15/2015 2:10 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/15/2015 2:10 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 1/15/2015 2:10 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/15/2015 2:10 PM |
| Details | Medicare Provider Number | Insert | | | | 1/15/2015 2:10 PM |
| Details | Entity Name | Insert | | | BIRMINGHAM HEALTH CARE INC | 1/15/2015 2:10 PM |
| Details | Program Code | Insert | | | CH | 1/15/2015 2:10 PM |
| Details | Entity Subname | Insert | | | Ensley Health Center | 1/15/2015 2:10 PM |
| Dates | Participating Approval Date | Insert | | | | 1/15/2015 2:10 PM |
| Details | State | Insert | | | Pending | 1/15/2015 2:10 PM |
| Dates | Registration Date | Insert | | | 1/15/2015 12:00:00 AM | 1/15/2015 2:10 PM |
| Dates | Signed By Date | Insert | | | 1/15/2015 12:00:00 AM | 1/15/2015 2:10 PM |
| Dates | Start Date | Insert | | | | 1/15/2015 2:10 PM |
| Terminations | Termination Comments | Insert | | | | 1/15/2015 2:10 PM |
| Terminations | Termination Date | Insert | | | | 1/15/2015 2:10 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/15/2015 2:10 PM |
| Terminations | Termination Reason | Insert | | | | 1/15/2015 2:10 PM |