Active NPI
Southern Surgical Associates, PA
- Surgery Physician
- Greenville, NC
National Provider Identifier
1154370104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- SOUTHERN SURGICAL ASSOCIATES, PA
- Practice address
- 2455 Emerald PL
Greenville, NC 27834-5785 - Phone
- (252) 758-2224
- Fax
- (252) 758-2860
- NPI assigned
- May 8, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Wade Naziri, M.D.
- Title
- President
- Phone
- (252) 758-2224
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
2455 Emerald PL
Greenville, NC 27834-5785
Mailing address
2455 Emerald PL
Greenville, NC 27834-5785
Phone (252) 758-2224
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5901798 | Medicaid | NC | |
| 017EX | Other | NC | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050818001043 | NC | Part B Supplier - Clinic/Group Practice | 4183654163 |
Receives reassigned benefits from 6 practitioners Practice locations: Greenville, NC |
National Provider Directory
National Provider DirectoryInteroperability endpoints
- https://api.platform.athenahealth.com/8736/brand/1/csg/1/fhir/r4
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1154370104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2455 EMERALD PL",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278345785",
"telephone_number": "252-758-2224",
"fax_number": "252-758-2860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2455 EMERALD PL",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278345785",
"telephone_number": "252-758-2224",
"fax_number": "252-758-2860"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN SURGICAL ASSOCIATES, PA",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-08",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "NAZIRI",
"authorized_official_first_name": "WADE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "252-758-2224",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5901798",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "017EX",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.