Thomas E Southern, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

01023497A Issued in IN

Practice address

3520 Guion Rd
Ste 301
Indianapolis, IN 46222-1672

Phone

(317) 926-1356

Fax

(317) 926-1465

NPI assigned

Nov 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Indiana University Health Care Associates, Inc

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1902032832
  NPD (past)
• Indianapolis Osteopathic Hospital Inc.

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1366589467

  Plastic and Reconstructive Surgery

  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363651200000",
    "number": "1104996370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 637999",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452637999",
            "telephone_number": "317-682-2030",
            "fax_number": "317-644-5060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 GUION RD",
            "address_2": "STE 301",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462221672",
            "telephone_number": "317-926-1356",
            "fax_number": "317-926-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHERN",
        "first_name": "THOMAS",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2013-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IN",
            "license": "01023497A",
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "IN",
            "license": "01023497A",
            "primary": false
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "IN",
            "license": "01023497A",
            "primary": false
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgery of the Hand",
            "state": "IN",
            "license": "01023497A",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IN",
            "license": "01023497A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000762785",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100073340A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Surgery Center LLC
• Brooke S. Southerland, PA-C
• Jara Lynn Southerland, NP
• Southern Hospitality Incorporated
• Southern Medical Corporation PC
• Southpointe Pediatrics, PC
• Southport Adult Day Center
• Southport Dental, P.C.
• Southport Smiles Family and Cosmetic Dentistry
• Southside Emergency Associates

• Plastic and Reconstructive Surgery Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Plastic and Reconstructive Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; 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.