Active NPI
Davood Sooriash, M.D.
- Surgery Physician
- Marion, IL
National Provider Identifier
1093828964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- ME26368
- Practice address
- 2401 W Main St
Marion, IL 62959-1188 - Phone
- (618) 997-5311
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | ME26368 | FL | Primary |
Addresses
Primary practice location
2401 W Main St
Marion, IL 62959-1188
Mailing address
1210 Black Diamond Dr Apt 5
Carbondale, IL 62901-5158
Phone (904) 868-6904
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 057778200 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME26368 | FL | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wuesthoff Memorial Hospital Inc | Past | Accepting new patients | |
| Southeast Volusia Medical Services Inc | Surgery | Past | Accepting new patients |
| Memorial Surgicare LTD | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- Jacksonville, FL
- NPI 1942263363
-
- Surgery Physician
- New Smyrna Beach, FL
- NPI 1104868876
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Rockledge, FL
- NPI 1164685756
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1093828964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 BLACK DIAMOND DR APT 5",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629015158",
"telephone_number": "904-868-6904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 W MAIN ST",
"city": "MARION",
"state": "IL",
"postal_code": "629591188",
"telephone_number": "618-997-5311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOORIASH",
"first_name": "DAVOOD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "FL",
"license": "ME26368",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "057778200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.