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Employee
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Contractor/Vendor
Please make sure you have a Business Associate Agreement (BAA) on file
If this provider needs access to Cerner and/or PACS they would have to be privileged as a community provider at minimum through the Medical Staff Office. Please work through them to get the physician the access they need:
medstaffcredentials@health.southalabama.edu
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Common provider titles are CW Clinical Psychologist, CW Speech Language Pathologist, CW Respiratory Therapist, Clinical Pharmacist, NGRNP, Nursing Instructor, MD, MA, CRNP and occasional RN's.
If you are not submitting for one of these titles, please use the Employee radial button to request an account.
Submitter Location:
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1720 Clinic
Adolescent and Young Adult Health Clinic
Allied Health
Alta Pointe
Children's & Women's Hospital
Cottage Hill Primary Care
Dauphin/I-65
Family Practice Associates
Freestanding Emergency Department
Hillcrest Primary Care
Information Technology
MAPP Campus
MAWSS
MCI - Fairhope Clinic
MCI - Mobile Clinic
Midtown Clinic
Mobile Diagnostic Center
Other
Pediatric Associates/USA Health
Peds Residency
Providence
Providence Airport Primary Care
Providence Bariatrics
Providence Citronelle Primary Care
Providence Diabetes Education
Providence Endocrinology
Providence Gastroenterology
Providence Podiatry
Providence Radiation Oncology
Providence Semmes Primary Care
Providence Snow Road Primary Care
Providence South Coast Family Practice
Providence Surgical Services
Providence Tillmans Corner Primary Care
Pulmonary Associates of Mobile
Semmes Pediatric Clinic
Spanish Fort OB/PEDS Clinic
Stanton Road Clinic
Strada Patient Care Center
Surgical Specialists
USA Campus
USA Eastern Shore
USA Endocrine & Diabetes
USA Health Badger Clinic
USA Health Care Authority (HCA)
USA Health Dermatology
USA Health Endocrinology West Mobile
USA Health Pain Management
University Commons
University Health Office Park (UHOP)
University Hospital
University OB-GYN
West Mobile Medical Group
West Mobile Primary Care
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Note: Select
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if User is changing departments
Kloud 7 User?
WARNING!
You are requesting to remove/terminate access for a USA Health provider. Only the USA Health Medical Staff Office can request this action to ensure compliance with the by-laws governing the medical staff. This ticket will not be submitted at this time. Please contact the Medical Staff Office with any questions by emailing medstaffcredentials@health.southalabama.edu or calling (251) 470-5805.
Note: If transferring, the
receiving department
should submit a ticket for transfer of access,
NOT
the
current
department.
USA J#:
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Secondary Contact Information
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Mobile Phone:
Provider Information
Provider Type:
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A=Attending USA
A=Attending Non-USA
APP=Advance Practice Professional Non-USA
AR=Ambulatory Referring
C=Ambulatory
CS=Community Staff USA
CS=Community Staff Non-USA
F=Academic Faculty
H=House Staff
APP=Advance Practice Professional
NAPP=Non-Advance Practice Professional
T=Diagnostic Testing (non-credentials)
Primary Specialty (Taxonomy):
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Anesthesiology
Audiology
Behavioral Development - Peds
Cardiology
Cardio Vascular Surgery
Clinical Psychology
Colon/Rectal Surgery
Emergency Medicine
Endocrinology
Family Medicine
Gastroenterology
General Internal Medicine/Peds
General Internal Medicine
General Pediatrics
General Surgery
Gynecologic Oncology
Hematology/Oncology
Hematopathology
Infectious Disease
Maternal/Fetal
Medical Genetics
Medical Oncology
Neonatal-Perinatal
Nephrology
Neurology
Neuroradiology
Neuroradiology/MSK
Neurosurgery
Nuclear Medicine
Nurse Midwife
Nurse Practitioner
Nurse Practitioner/Oncology
OB/GYN
Occupational Therapy
Ophthalmology
Orthopaedic Trauma
Orthopaedics
Otolarngology
Pain Management
Pathology
Peds Hematology/Oncology
Peds Infectious Disease
Pediatric Cardiology
Pediatric Critical Care
Pediatric Emergency Medicine
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Hospitalist
Pediatric Nephrology
Pediatric Neurology
Pediatric Pathology
Pedatric Radiology
Pediatric Rheumatology
Pediatric Surgery
Pediatric Urology
Physical Therapy
Physcian Assistant
Psychiatry
Pulmonary
Radiation Oncology
Radiology - Diagnostic
Radiology - Vascular/Interventional
Reconstructive Plastic Surgery
Registered Nurse
Reproductive Endocrinology
Rheumatology
Sickle Cell/Pulmonary
Sleep Disorders
Social Worker
Speech-Language Pathology
Surgical Critical Care
Surgical Oncology
Thoracic Surgery
Transfusion Medicine
Trauma
Urology
Secondary Specialty (Taxonomy):
Anesthesiology
Audiology
Behavioral Development - Peds
Cardiology
Cardio Vascular Surgery
Clinical Psychology
Colon/Rectal Surgery
Emergency Medicine
Endocrinology
Family Medicine
Gastroenterology
General Internal Medicine/Peds
General Internal Medicine
General Pediatrics
General Surgery
Gynecologic Oncology
Hematology/Oncology
Hematopathology
Infectious Disease
Maternal/Fetal
Medical Genetics
Medical Oncology
Neonatal-Perinatal
Nephrology
Neurology
Neuroradiology
Neuroradiology/MSK
Neurosurgery
Nuclear Medicine
Nurse Midwife
Nurse Practitioner
Nurse Practitioner/Oncology
OB/GYN
Occupational Therapy
Ophthalmology
Orthopaedic Trauma
Orthopaedics
Otolarngology
Pain Management
Pathology
Peds Hematology/Oncology
Peds Infectious Disease
Pediatric Cardiology
Pediatric Critical Care
Pediatric Emergency Medicine
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Hospitalist
Pediatric Nephrology
Pediatric Neurology
Pediatric Pathology
Pedatric Radiology
Pediatric Rheumatology
Pediatric Surgery
Pediatric Urology
Physical Therapy
Physcian Assistant
Psychiatry
Pulmonary
Radiation Oncology
Radiology - Diagnostic
Radiology - Vascular/Interventional
Reconstructive Plastic Surgery
Registered Nurse
Reproductive Endocrinology
Rheumatology
Sickle Cell/Pulmonary
Sleep Disorders
Social Worker
Speech-Language Pathology
Surgical Critical Care
Surgical Oncology
Thoracic Surgery
Transfusion Medicine
Trauma
Urology
Title (MD, PA, PA-C, etc.):
Provider/MSI#:
No Admitting Privilege
Admitting Privilege UH
Admitting Privilege CW
SSN:
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DOB (mm/dd/yyyy):
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DEA#:
Medical License #:
Issuing State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
If Provider
does not
have a J-Number, please enter their home address:
Office Address:
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Other
Mobile Diagnostic 6701 Airport Blvd, Suite A-101 Mobile, AL 36608
Mobile Diagnostic - Commons - 75 S. University Blvd, Ste 6500, Mobile, AL 36608
University Urology 3290 Dauphin St, Suite 400 Mobile, AL 36606
University OBGYN 524 Stanton Rd Mobile, AL 36617
USA Adolescent Medicine 1601 Center Street, Suite 1D Mobile, AL 366081512
USA AHP Physical Therapy Student Rec Center 51 Stadium Blvd, Room 218 Mobile, AL 366880002
USA Anatomical Pathology Lab 2451 University Hospital Drive, Moorer Bldg. Mobile, AL 366172238
USA Cardiac Catheterization Lab 2451 University Hospital Drive, Building C Mobile, AL 366172238
USA Cardiology Clinic 2451 University Hospital Drive, Building C Mobile, AL 366172238
USA Center for Women's Health - Chatom 14634 St Stephens Avenue, Suite B Chatom, AL 365186711
USA Center for Women's Health - Fairhope 188 Hospital Drive, Suite 400 Fairhope, AL 365186711
USA Center for Women's Health - Jackson 227 Hospital Drive Jackson, AL 365452423
USA Center for Women's Health - Mobile 1601 Center Street Suite 3S Mobile, AL 366041512
USA Children's and Women's Hospital 1700 Center Street Mobile, AL 366043301
USA Ctr for Women's Hlth Diagnostic Maternal Fetal 1601 Center Street, Suite 3S Mobile, AL 366041512
USA Dept. of Anesthesiology 2451 University Hospital Drive, Mastin 216 Mobile, AL 366172238
USA Dept. of Clinical Psychology 307 University Blvd. N. Mobile, AL 36688
USA Dept. of EM/Children's 1700 Center Street Mobile, AL 366043301
USA Dept. of Emergency Medicine 2451 University Hospital Drive, UMC 10-L Mobile, AL 36617
USA Dept. of Family Practice 1601 Center St, Suite 2N Mobile, AL 36604
USA Dept. of Internal Medicine 2451 University Hospital Drive, Mastin 400L Mobile, AL 366172238
USA Dept. of Medical Genetics CCCB 214 Mobile, AL 36688
USA Dept. of Medicine/Cardiology 2451 University Hospital Drive, UMC 10-B Mobile, AL 366172238
USA Dept. of Medicine/GI Division 75 S University Blvd, UCOMM 6000B Mobile, AL 366880002
USA Dept. of Medicine/Infectious 2451 University Hospital Drive, Mastin 400G Mobile, AL 366172238
USA Dept. of Medicine/Nephrology 2451 University Hospital Drive, Mastin 503 Mobile, AL 366172238
USA Dept. of Medicine/Pulmonary 2451 University Hospital Drive, UMC 10-G Mobile, AL 366172238
USA Dept. of Neurology - Academic 2451 University Hospital Drive, 10-A Mobile, AL 366172238
USA Dept. of Neurology/Child/Strada 1601 Center Street, Suite 2S Mobile, AL 366041512
USA Dept. of Neurosurgery Academic 2451 University Hospital Drive, Suite 10-A Mobile, AL 366172238
USA Dept. of Neurology/Strada 1601 Center Street, Suite 2S Mobile, AL 366041512
USA Dept. of OB/GYN 251 Cox Street, Suite 100 Mobile, AL 36604
USA Dept. of OB/GYN/Repro/Endo 307 University Blvd, HSB 2200 Mobile, AL 36688
USA Dept. of Othopaedic Surgery 1601 Center Street, Suite 3N Mobile, AL 366041512
USA Dept. of Pathology 2451 University Hospital Drive, Moorer Building Rm 115 Mobile, AL 366172238
USA Dept. of Pediatrics - Academic 1601 Center Street, Suite 1271, Mobile, AL 366041405
USA Dept. of Pediatrics - Children's 1601 Center Street , Suite 1N Mobile, AL 366041512
USA Dept. of Pediatrics/Adolescent 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Dept. of Pediatrics/Cardiology 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Dept. of Pediatrics/Critical Care 251 Cox Street, CWEB 1547 Mobile, AL 36604
USA Dept. of Pediatrics/Developmental 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Dept. of Pediatrics/Endocrinology 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Dept. of Pediatrics/Hospitalist 251 Cox Street, CWEB 1547 Mobile, AL 36604
USA Dept. of Pediatrics/Infectious 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Dept. of Pediatrics/Medical 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Dept. of Pediatrics/Neonatal 1700 Center Street, CWEB 1 RM1171 Mobile, AL 36604
USA Dept. of Pediatrics/Nephrology 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Dept. of Pediatrics/Residency 251 Cox Street, CWEB 1 RM 1536 Mobile, AL 36604
USA Dept. of Radiology 2451 University Hospital Drive, Mastin 301 Mobile, AL 366172238
USA Dept. of Surgery - Strada Patient 1601 Center Street, Suite 2N Mobile, AL 366041512
USA Dept. of Surgery 2451 University Hospital Drive, Mastin 719 Mobile, AL 366172238
USA Dept. of Surgery (Trauma) 2451 University Hospital Drive, Suite 10 I Mobile, AL 366172238
USA Dept. of Surgery/Colon and Rectal 2451 University Hospital Drive, Mastin 703 Mobile, AL 366172238
USA Dept. of Surgery/Pediatrics 1700 Center Street Mobile, AL 366043301
USA Dept. of Surgery/Plastic Surgery 1601 Center Street, Suite 2N Mobile, AL 366041512
USA Developmental Behavioral 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Digestive Diseases Center 75 S University Boulevard, UCOM 6000 B Mobile, AL 366083042
USA Endocrinology Clinic 2451 University Hospital Drive, Suite 102 Mobile, AL 366172238
USA Family Medicine Center 1601 Center St, Suite 2N Mobile, AL 366043207
USA Family Specialty Clinic - Adults 2451 University Hospital Drive, Mastin 102 Mobile, AL 366172238
USA Family Specialty Clinic - Peds 1601 Center Street, Suite 1S Mobile, AL 366041512
USA General Int Medicine 2451 University Hospital Drive, Suite 102 Mobile, AL 366172238
USA General Pediatrics - Faculty 1601 Center Street, Suite 1S Mobile, AL 366041512
USA General Pediatrics - Residency 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Genetics Lab 2451 University Hospital Drive, Moorer Bldg. Mobile, AL 366172238
USA HemOnc Clinic 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Infectious Disease - Mastin 2451 University Hospital Drive, Suite 102 Mobile, AL 366172238
USA Interventional Radiology at MCI 1660 Springhill Avenue Mobile, AL 366041405
USA Mammography - SPCC 1601 Center Street, Suite 2N Mobile, AL 366041512
USA Medical Center 2451 University Hospital Drive Mobile, AL 366172238
USA Medical Center Cyberknife 1660 Springhill Avenue Mobile, AL 366041405
USA Nephrology Specialist - Mastin 2451 University Hospital Drive, Suite 102 Mobile, AL 366172238
USA Neurology Clinic 1601 Center Street, Suite 2S Mobile, AL 366041512
USA Neurosurgery Clinic 1601 Center Street, Suite 2S Mobile, AL 366041512
USA OBGYN Clinic 1720 Center Street, Suite 103 Mobile, AL 366043300
USA Orthopaedics Surgery 1601 Center Street, Suite 3N Mobile, AL 366041512
USA Orthopedic Rehab 1601 Center Street, Suite 3N Mobile, AL 366041512
USA Pediatric Adolescent 1601 Center Street, Suite 3N Mobile, AL 366041512
USA Pediatric Cardiology - Foley 1711 N. Mckenzie Street, Suite 102 Foley, AL 36535
USA Pediatric Cardiology - SPCC 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Pediatric Endocrinology 1601 Center Street , Suite 1S Mobile, AL 366041512
USA Pediatric Genetics 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Pediatric GI 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Pediatric Healthy Life Center 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Pediatric Infectious Disease 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Pediatric Nephrology 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Pediatric Therapy Services 1610 Center Street, Suite B Mobile, AL 366041512
USA Pediatrics 1601 Center Street, Suite 1N Mobile, AL 366041512
USA Peds ROP Clinic 1601 Center Street, Suite 1S Mobile, AL 366041512
USA Psychiatry Clinic 1015 Montlimar Dr, Suite A210 Mobile, AL 366091743
USA Pulmonary - Mastin 2451 University Hospital Drive, Suite 102 Mobile, AL 366172238
USA Radiologic Sciences 5721 USA Drive North, HAHN 3015 Mobile, AL 366883053
USA Radiology AHP 2451 University Hospital Drive Mobile, AL 366172238
USA Radiology SPCC 1601 Center Street, Suite 3N Mobile, AL 366041512
USA Repro Endocrine 1601 Center Street, Suite 3S Mobile, AL 366041512
USA Rheumatology - Mastin 2451 University Hospital Drive, Suite 102 Mobile, AL 366172238
USA SANE Nurses 1700 Center Street Mobile, AL 366043301
USA Speech and Hearing Clinic 5721 USA Drive North, HAHN 1119 Mobile, AL 366883053
USA Stanton Road Clinic 575 Stanton Road Mobile, AL 366172344
USA Student Health Center 5870 Alumni Circle Mobile, AL 366080002
USA Surgical Specialists - Mastin 2451 University Hospital Drive, Suite 101 Mobile, AL 366172238
USA Surgical Specialists - MCI 1660 Springhill Avenue, Suite 3069 Mobile, AL 366041405
USA Surgical Specialist - SPCC 1601 Center Street, Suite 2N Mobile, AL 366041512
USA University Physicians Group 75 S University Boulevard, UCOM 6000 A Mobile, AL 366880002
USA USS Hope Clinic 1700 Center Street, 1st Floor Mobile, AL 366043301
USA Mitchell Cancer Institute 1660 Springhill Avenue Mobile, AL 366041405
Specify if Other:
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*Other - Specify in Comments
Accountant
Accounts Payable
Advanced Endoscopy Scrub Tech
Advanced MA
AP Cytotechnologist
AP Histotechnologist
AP Lab Assistant
AP Secretary
Athletic Trainer
Auburn Pharmacy Student
Audiologist
Billing Specialist
Burn Unit RN
Care Access Associate
Care Access Referral Specialist
Care Management
CCCA
Clinical Dietitian
Clinical Pharmacist
Clinical Programmer
Clinical Transformation Specialist
Clinician
Coder
Coordinator Practice Operations
CRNA
CRNP
Custodial Worker
CW Cashier
CW Clinical Psychologist
CW Medical Lab Technologist
CW Medical Records
CW NICU RN
CW Patient Access Rep
CW Pharmacist
CW Pharmacy Technician
CW PICU RN
CW Respiratory Therapist
CW RN
CW ROI Specialist
CW RTN L&D
CW Secretary
CW Security Officer
CW Speech Language Pathologist
CW Ward Clerk
Desktop Support Technician
Digital Marketing Specialist
EEG Technician
External Research Monitor - Clinical Trials
Fairhope Pediatrics Clinical Nurse Practitioner
Help Desk Technician
HIM Clerk
HIM Coder
Hospital Administrator
HouseStaff
HR Assistant
Informatics Specialist
Internal Audit
IT and Biomedical Trainer
IT Audit Cleark
IT Clinical Lab Coordinator
IT Quality and Compliance
IT Security
Laboratory Assistant
LPN
MA
Manager Employee Assistance Program
Manager Practice Operations
Marketing
MD
Medical Student - VIEW ONLY
Medical Student Provider
Medical Teaching Technologist
NGRNP
Nuance Scribe
Nurse Manager
Nurse Practitioner Student
Nursing Instructor
OB Technician
Occupational Therapist
Occupational Therapy Student
Paramedic
Patient Relations Coordinator
Patient Transport Aide
PCA
Pharmacy Student
Phlebotomist
Physical Therapist
Physical Therapy Assistant
Physical Therapy Student
Physicians Assistant
Physicians Assistant Student
Preservice Representative
PRN Sitter
Project Manager
Psychologist Student
Purchasing Specialist
Quality and Performance Improvement Coordinator
Radiologic Student Technologist
Radiologic Technologist
Radiologist
Recruiter
Respiratory Therapy Assistant
Respiratory Therapy Student
Respiratory Therapy Tech
RN
Scribe
Speech Therapist
Speech Therapy Student
SPM
Sterile Processing Tech
Strada Administrative Assistant
Student Nurse
Telemetry Technician
Temp RN
Transfer Center Specialist
Trauma Scrub Tech
Travel RN
UH Clinical Laboratory Medical Tech
UH Clinical Laboratory Phlebotomist
UH Credentialing Specialist
UH Department Assistant
UH Diagnostic Scheduler
UH Medical Records DRG/APC Coordinator
UH Patient Access Rep
UH Pharmacist
UH Pharmacy
UH Pharmacy Tech
UH Quality
UH RN
UH Secretary
UH Security Guard
UH Social Worker
UH Sterile Processing Tech
UH Supply Inventory Technician
UH Trauma Registrar
UH Ward Clerk
Ultrasonographer
Vulcan Radiologist
Access Role:
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Select Vendor
*Other, Specify in Comments
ACS Coders
Alta Pointe Vendor
Coastal Neurology Institute
Coronis Health Vendor
CRS Contracted Employee
Data Abstractor
Dr. Ronald Clark (OBGYN)
Ensemble Health Partner
Experian Information Technology
Franklin Primary Care
Gulf Coast Pediatric Care
Gulf Coast Total Care
Harmony
Healthcare IT Leaders
Hit_That_Noggin
Intellis Management
Legacy of Hope Users
Nuance Communications
Optum Advisory Board
Phreesia Senior Client Success Associate
PPM Partners
Pulmonary Associates of Mobile
Quest Diagnostics
Scribekick
Snelling Contract Labor Temp
Softek Vendors
Synergy IT
TekLinks
TEKSystems
The Bienville Group_Pulmonary Associate of Mobile_ PC _ Billing
United Healthcare Rep
Vulcan Imaging/MSN billing
Vulcan Radiology_MSN Healthcare Solutions
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