Southside Family Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SOUTHSIDE FAMILY MEDICAL GROUP, LLC

Practice address

5955 S Emerson Ave
Suite 100
Indianapolis, IN 46237-2600

Phone

(317) 789-9600

Fax

(317) 789-0600

NPI assigned

Oct 6, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Chris A Goul

Title

Practice Manager

Phone

(317) 452-8400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cynthia Suzzanne Williams, M.D.

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1093756348
  Medicare reassignment Care Compare group NPD
• David D Williams, M.D.

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1164490538
  Medicare reassignment Care Compare group NPD
• Rhonda Goul, M.D.

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1023086725
  Medicare reassignment NPD
• Brian C Ruley, MD

  • Family Medicine Physician
  • Rushville, IN
  • NPI 1386758639
  Medicare reassignment NPD

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1215024674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 S EMERSON AVE",
            "address_2": "SUITE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462372600",
            "telephone_number": "317-452-8400",
            "fax_number": "317-452-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 S EMERSON AVE",
            "address_2": "SUITE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462372600",
            "telephone_number": "317-789-9600",
            "fax_number": "317-789-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FAMILY MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "GOUL",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "317-452-8400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southport Adult Day Center
• Southport Dental, P.C.
• Southport Smiles Family and Cosmetic Dentistry
• Southside Emergency Associates
• Southside Eye Associates
• Southside Family Physicians, Inc
• Southside Internal Medicine PC
• Southside OB-GYN PC
• Southside Pediatrics, Inc.
• Southside Physical Therapy Clinic

• Family Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; 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.