NPIMap

Organization Active NPI

Southeastern Medical Group, PC

  • Hospitalist Physician
  • Brevard, NC
National Provider Identifier
1184669053
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
SOUTHEASTERN MEDICAL GROUP, PC
Practice address
260 Hospital Dr
Brevard, NC 28712-3378
Phone
(828) 884-9111
NPI assigned
Jun 17, 2006
Last updated
Oct 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Authorized official

Name
Dr. Randal L Dabbs, M.D.NPI 1326095035
Title
President
Phone
(865) 693-1000

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Hospitalist Physician 208M00000X NU Primary

Addresses

Primary practice location

260 Hospital Dr
Brevard, NC 28712-3378

Mailing address

PO Box 636020
Cincinnati, OH 45263-6020

Other identifiers 4

IdentifierTypeStateIssuer
611073900OtherTNUS DEPT LABOR
1184669053MedicaidNC
3705406MedicaidTN
DD8348OtherTNRRGA MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20241021000535 NC Part B Supplier - Clinic/Group Practice 8921030719 Receives reassigned benefits from 268 practitioners
Practice locations: Brevard, NC; Franklin, NC; Highlands, NC; Roxboro, NC; Spruce Pine, NC
O20260518002542 VA Part B Supplier - Clinic/Group Practice 8921030719 Receives reassigned benefits from 7 practitioners
Practice locations: Wytheville, VA

National Provider Directory

National Provider Directory

Locations

801 Vanosdale Rd
Knoxville, TN 37909
Phone (865) 690-3411

Practitioners & affiliated clinicians

Practitioners 280

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 280

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1184669053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636020",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 HOSPITAL DR",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287123378",
            "telephone_number": "828-884-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "DABBS",
        "authorized_official_first_name": "RANDAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "865-693-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT LABOR",
            "identifier": "611073900",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184669053",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3705406",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRGA MEDICARE",
            "identifier": "DD8348",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brevard, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.