NPIMap

Organization Active NPI

Southern Obstetric & Gyneco Associates

Doing business as Southern OB/GYN

  • Obstetrics & Gynecology Physician
  • Greenville, IL
National Provider Identifier
1205199452
Registry record updated Jun 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036100027 Issued in IL
Legal business name
SOUTHERN OBSTETRIC & GYNECO ASSOCIATES
Doing business as
Southern OB/GYN
Practice address
700 S Dewey St
Greenville, IL 62246-2288
Phone
(618) 526-2209
Fax
(618) 526-7737
NPI assigned
Jun 22, 2012
Last updated
Jun 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2012

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

Authorized official

Name
Dr. Anne E Doll-Pollard, M.D.NPI 1881652626
Title
President
Phone
(618) 526-2209

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 036100027 IL Primary

Addresses

Primary practice location

700 S Dewey St
Greenville, IL 62246-2288

Mailing address

9447 Holy Cross LN
Breese, IL 62230-3510
Phone (618) 526-2209

Other identifiers 1

IdentifierTypeStateIssuer
042005236OtherILCORPORATE LICENSE

Other names 1

  • Southern OB/GYN Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041130000387 IL Part B Supplier - Clinic/Group Practice 7315902509 Receives reassigned benefits from 10 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Breese, IL; Greenville, IL; Highland, IL; Salem, IL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

9447 Holy Cross Ln
Breese, IL 62230
Phone (618) 526-2209

1345 S State Route 127
Greenville, IL 62246
Phone (618) 664-2457

100 Woodcrest Dr
Highland, IL 62249
Phone (618) 526-2209

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340323200000",
    "number": "1205199452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9447 HOLY CROSS LN",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303510",
            "telephone_number": "618-526-2209",
            "fax_number": "618-526-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S DEWEY ST",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462288",
            "telephone_number": "618-526-2209",
            "fax_number": "618-526-7737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OBSTETRIC & GYNECO ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-22",
        "last_updated": "2012-06-22",
        "status": "A",
        "authorized_official_last_name": "DOLL-POLLARD",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-526-2209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036100027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE LICENSE",
            "identifier": "042005236",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; 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.