Southern Medical Group LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

SOUTHERN MEDICAL GROUP LLC

Practice address

5233 E Southern Ave Ste 103
Mesa, AZ 85206-3628

Phone

(480) 830-2882

Fax

(480) 830-2881

NPI assigned

Dec 20, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Derek Paul Pruni, DC

Title

Member

Phone

(412) 889-0636

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545264000000",
    "number": "1053883546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5233 E SOUTHERN AVE STE 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063628",
            "telephone_number": "480-830-2882",
            "fax_number": "480-830-2881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5233 E SOUTHERN AVE STE 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063628",
            "telephone_number": "480-830-2882",
            "fax_number": "480-830-2881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-20",
        "last_updated": "2018-12-20",
        "status": "A",
        "authorized_official_last_name": "PRUNI",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "412-889-0636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physical Medicine & Rehabilitation Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.