Southeastern Plastic Surgery Assoc., PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

10631 Issued in AL

Legal business name

SOUTHEASTERN PLASTIC SURGERY ASSOC., PC

Practice address

100 Towncenter Blvd Ste 111
Tuscaloosa, AL 35406-1832

Phone

(205) 330-8820

Fax

(205) 333-2515

NPI assigned

Feb 8, 2007

Last updated

Oct 2, 2026By 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

Dr. Luis R Pernia, M.D.NPI 1174504336

Title

Surgeon

Phone

(205) 330-8820

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MS, AL2 enrollments

Enrollment records 2

Locations

Practitioners 2

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.

• Luis Ronald Pernia, M.D.

  • Specialist
  • Tuscaloosa, AL
  • NPI 1174504336

  MS

  Medicare reassignment NPD Authorized official
• Robert P Bolling, MD

  • Plastic and Reconstructive Surgery Physician
  • Tuscaloosa, AL
  • NPI 1477509925
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790899200000",
    "number": "1124168927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 TOWNCENTER BLVD STE 111",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354061832",
            "telephone_number": "205-330-8820",
            "fax_number": "205-333-2515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 TOWNCENTER BLVD STE 111",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354061832",
            "telephone_number": "205-330-8820",
            "fax_number": "205-333-2515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PLASTIC SURGERY ASSOC., PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A",
        "authorized_official_last_name": "PERNIA",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SURGEON",
        "authorized_official_telephone_number": "205-330-8820",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "10631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "240000037",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528501310",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MS",
            "identifier": "441666528B",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL",
            "identifier": "51014573",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Physician Network, LLC
• Southeast Physician Network, P.C.
• Southeast Physician Network, P.C.
• Southeastern Hearing Services, Inc.
• Southeastern Pain & Rehabilitation Physicians, PC
• Southeastern Plastic Surgery, LLC
• Southeastern Spine Specialists Inc
• Southern Diagnostic Laboratories, LLC
• Southern Family Markets LLC (Brunos Food and Pharmacy)
• Southern NP Associates, LLC

• Specialist in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Specialist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2026; 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.