NPIMap

Organization Active NPI

Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
National Provider Identifier
1083835441
Registry record updated Jan 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
SOUTHEASTERN PHYSICIAN SERVICES PC
Practice address
990 Oak Ridge Tpke
Oak Ridge, TN 37830-6976
Phone
(865) 481-1000
NPI assigned
May 2, 2007
Last updated
Jan 31, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2020

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

Authorized official

Name
Dr. Randal L Dabbs, MDNPI 1326095035
Title
President
Phone
(888) 203-1274

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Physician Assistant 363A00000X TN
Medical Physician Assistant 363AM0700X
Nurse Practitioner 363L00000X TN
Internal Medicine Physician 207R00000X TN
Orthopaedic Surgery Physician 207X00000X
Hospitalist Physician 208M00000X TN Primary

Addresses

Primary practice location

990 Oak Ridge Tpke
Oak Ridge, TN 37830-6976

Mailing address

PO Box 635705
Cincinnati, OH 45263-5705
Phone (888) 203-1274

Other practice location 1

1100 Brookhaven Rd
Franklin, KY 42134-2746
Phone (270) 745-1212

Other identifiers 5

IdentifierTypeStateIssuer
529932974MedicaidAL
3370208MedicaidTN
5950338MedicaidNC
GP5012MedicaidSC
7100046370MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA, KY, MO, MS5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20071025000571 TN Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 1,105 practitioners
O20081229000558 VA Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 63 practitioners
Practice locations: Wytheville, VA; Wise, VA; Abingdon, VA; Weber City, VA; Richmond, VA; Lebanon, VA; Grundy, VA; Duffield, VA…
O20090715000150 KY Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 390 practitioners
Practice locations: Paducah, KY; Maysville, KY; Madisonville, KY; Lexington, KY; Horse Cave, KY; Hartford, KY; Glasgow, KY; Flemingsburg, KY…
O20160809000235 MO Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 204 practitioners
Practice locations: Saint Peters, MO; Saint Louis, MO; O Fallon, MO; Ferguson, MO
O20160831001321 MS Part B Supplier - Clinic/Group Practice 0042307852 Receives reassigned benefits from 1 practitioner
Practice locations: Grenada, MS; Holly Springs, MS; Southaven, MS

National Provider Directory

National Provider Directory

Locations

3300 Texas Ave
Saint Louis, MO 63118
Phone (314) 773-3408

3715 Saint Anns Ln
Saint Louis, MO 63121
Phone (314) 383-3353

278 Dry Valley Rd
Cookeville, TN 38506
Phone (931) 537-6524

8045 Roane Medical Center Dr
Harriman, TN 37748
Phone (865) 316-1000

336 W Old Andrew Johnson Hwy
Jefferson City, TN 37760
Phone (423) 440-8810

403 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-7042

3641 Memorial Blvd
Kingsport, TN 37664
Phone (423) 246-2411

307 N 5th St
Maryville, TN 37804
Phone (423) 983-0261

501 W Economy Rd
Morristown, TN 37814
Phone (423) 581-5432

415 Cole Dr
Pigeon Forge, TN 37863
Phone (865) 428-5454

146 Buck Creek Rd
Roan Mountain, TN 37687
Phone (423) 772-0161

165 Coffey Ln
Rutledge, TN 37861
Phone (423) 307-9022

1423 Main St
Sneedville, TN 37869
Phone (423) 733-4783

895 Powers Blvd
Waverly, TN 37185
Phone (931) 296-7552

574 Cummings St
Abingdon, VA 24210
Phone (276) 623-8330

500 Clinic Dr
Cedar Bluff, VA 24609
Phone (276) 276-7357

318 E Main St
Lebanon, VA 24266
Phone (276) 889-0733

Practitioners & affiliated clinicians

Practitioners 1,861

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 1,861

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1083835441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635705",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635705",
            "telephone_number": "888-203-1274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 OAK RIDGE TPKE",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378306976",
            "telephone_number": "865-481-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Brookhaven Rd",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "KY",
            "postal_code": "421342746",
            "country_code": "US",
            "telephone_number": "270-745-1212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEASTERN PHYSICIAN SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "DABBS",
        "authorized_official_first_name": "RANDAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-203-1274",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529932974",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3370208",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950338",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5012",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100046370",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Ridge, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.