Charles C Southerland, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

9244891-0501 Issued in UT

Practice address

3435 E Pony Express Pkwy Ste 140
Eagle Mountain, UT 84005-5548

Phone

(801) 893-8811

NPI assigned

Sep 20, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Barry University Inc

  • Foot & Ankle Surgery Podiatrist
  • North Miami Beach, FL
  • NPI 1295959625
  Medicare reassignment NPD
• Barry University Inc

  • Foot & Ankle Surgery Podiatrist
  • Miami Beach, FL
  • NPI 1255631552
  NPD
• Barry University Inc

  • Foot & Ankle Surgery Podiatrist
  • Miami, FL
  • NPI 1821216615
  NPD

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587686400000",
    "number": "1306832944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11300 NE 2ND AVENUE",
            "city": "MIAMI SHORES",
            "state": "FL",
            "postal_code": "33161",
            "telephone_number": "305-693-7287",
            "fax_number": "305-694-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3435 E PONY EXPRESS PKWY STE 140",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "840055548",
            "telephone_number": "801-893-8811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1973 N State St",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846041012",
            "country_code": "US",
            "telephone_number": "801-373-2499",
            "fax_number": "801-373-5200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8822 S Redwood Rd Ste E121",
            "address_purpose": "LOCATION",
            "city": "West Jordan",
            "state": "UT",
            "postal_code": "840885763",
            "country_code": "US",
            "telephone_number": "801-285-7060",
            "fax_number": "801-285-7061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUTHERLAND",
        "first_name": "CHARLES",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "UT",
            "license": "9244891-0501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "9244891-0501",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Simpson
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• SLPD Em, LLC
• Jacob Shane Smith, ACMHC
• Justin Gregory Sommers
• Tahsha T Spackman, WHNP-BC
• Lauren Spencer
• Sharon K Sperry, RN
• Stages Family Therapy PLLC
• Michael Jarom Staheli, DNP, FNP-C, APRN

• Foot & Ankle Surgery Podiatrist in Eagle Mountain, UT
• Providers in Eagle Mountain, UT by specialty
• Foot & Ankle Surgery Podiatrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.