Active NPI
Southern Medical Group LLC
- Family Medicine Physician
- Magnolia, AR
National Provider Identifier
1073544508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- SOUTHERN MEDICAL GROUP LLC
- Practice address
- 211 E Stadium
Magnolia, AR 71753-2032 - Phone
- (870) 234-5995
- Fax
- (870) 234-0278
- NPI assigned
- Jul 5, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jean Morris, BILLING
- Title
- Billing
- Phone
- (870) 234-5995
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Internal Medicine Physician | 207R00000X |
Addresses
Primary practice location
211 E Stadium
Magnolia, AR 71753-2032
Mailing address
211 E Stadium
Magnolia, AR 71753-2032
Phone (870) 234-5995
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D0991904 | Southern Medical Group | Compliance | Jun 21, 2028 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Magnolia, AR
- NPI 1407848922
AR, Internal Medicine
-
- Family Nurse Practitioner
- Magnolia, AR
- NPI 1942237771
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1340064000000",
"number": "1073544508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 E STADIUM",
"city": "MAGNOLIA",
"state": "AR",
"postal_code": "717532032",
"telephone_number": "870-234-5995",
"fax_number": "870-234-0278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 E STADIUM",
"city": "MAGNOLIA",
"state": "AR",
"postal_code": "717532032",
"telephone_number": "870-234-5995",
"fax_number": "870-234-0278"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN MEDICAL GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-05",
"last_updated": "2012-06-19",
"status": "A",
"authorized_official_last_name": "MORRIS",
"authorized_official_first_name": "JEAN",
"authorized_official_title_or_position": "BILLING",
"authorized_official_telephone_number": "870-234-5995",
"authorized_official_credential": "BILLING"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Magnolia, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.