Southcare Medical LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHCARE MEDICAL LLC

Practice address

110 Curran LN
Lafayette, LA 70506

Phone

(337) 706-7700

Fax

(337) 706-7710

NPI assigned

Dec 30, 2015

Last updated

Oct 5, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Budi Sugeng, MDNPI 1649303330

Title

MD

Phone

(337) 422-6240

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Southcare Medical LLC

  • Rural Health Clinic/Center
  • Abbeville, LA
  • NPI 1215294830

  O20140604002027

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Southcare Medical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southcare Medical LLC

  • Rural Health Clinic/Center
  • Abbeville, LA
  • NPI 1215294830
  NPD tax ID

Practitioners 3

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.

• Budi N Sugeng, MD

  • Pediatrics Physician
  • Abbeville, LA
  • NPI 1649303330
  NPD Authorized official
• Simone Adel Pitre, C-NP

  • Primary Care Nurse Practitioner
  • Abbeville, LA
  • NPI 1437160231
  NPD
• Summer Lynn Smith, APRN

  • Family Nurse Practitioner
  • Delcambre, LA
  • NPI 1295339679
  NPD

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

{
    "created_epoch": "1451433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664928000000",
    "number": "1093170433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 CURRAN LN",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 CURRAN LN",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70506",
            "telephone_number": "337-706-7700",
            "fax_number": "337-706-7710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCARE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-30",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "SUGENG",
        "authorized_official_first_name": "BUDI",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "337-422-6240",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP07807",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD200292",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2409930",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA WAIVER",
            "identifier": "19D2091426",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kelly S. Sorrells, MD
• Maryanne Yacoub Sourial, DO
• Mina Sourial, M.D.
• Southdown Consulting LLC
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• Stella M. Souther, NP
• Southern Diagnostic Center, Inc. (Laborde Diagnotics at South College)
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• Primary Care Clinic/Center in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Primary Care Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.

Verify at the official NPI Registry.