NPIMap

Organization Active NPI

Southern OBGYN LLC

  • Obstetrics & Gynecology Physician
  • Lafayette, LA
National Provider Identifier
1174015945
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SOUTHERN OBGYN LLC
Practice address
155 Hospital Dr Ste 410
Lafayette, LA 70503-2852
Phone
(337) 235-4460
NPI assigned
Jun 6, 2018
Last updated
Jun 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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

Authorized official

Name
Dr. Jennifer Pugliese, M.D.NPI 1235267279
Title
M.D./Partner
Phone
(337) 591-0147

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)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

155 Hospital Dr Ste 410
Lafayette, LA 70503-2852

Mailing address

155 Hospital Dr Ste 410
Lafayette, LA 70503-2852

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181106000949 LA Part B Supplier - Clinic/Group Practice 0446503627 Receives reassigned benefits from 20 practitioners
Practice locations: Lafayette, LA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2151909Southern OBGYN, LLC155 Hospital Dr, Suite 410, Lafayette, LA 70503Certificate of waiverJul 30, 2026

National Provider Directory

National Provider Directory

Locations

155 Hospital Dr
Lafayette, LA 70503
Phone (337) 235-7743

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528243200000",
    "number": "1174015945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 HOSPITAL DR STE 410",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 HOSPITAL DR STE 410",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032852",
            "telephone_number": "337-235-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OBGYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A",
        "authorized_official_last_name": "PUGLIESE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "M.D./PARTNER",
        "authorized_official_telephone_number": "337-591-0147",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; 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.