Individual provider Active NPI

Marcy G Southwell, PA C

  • Medical Physician Assistant
  • Concord, NH
National Provider Identifier
1306882881
Registry record updated Dec 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0391P Issued in NH
Practice address
60 Commercial St
Suite 404
Concord, NH 03301-5071
Phone
(603) 228-1763
Fax
(603) 228-7088
NPI assigned
Jun 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0391P NH Primary

Addresses

Primary practice location

60 Commercial St
Suite 404
Concord, NH 03301-5071

Mailing address

60 Commercial St
Suite 404
Concord, NH 03301-5071
Phone (603) 228-1763

Other identifiers 1

IdentifierTypeStateIssuer
30332153MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041108000420 NH Practitioner - Physician Assistant 9234192683 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concord Hospital IncGroup PAC ID 6103721790, 572 clinicians

Practice addresses (Care Compare)

250 Pleasant St
Concord, NH 03301-2598

250 Pleasant St
Concord, NH 03301-7559
Phone (603) 230-3138

60 Commercial St
Concord, NH 03301-5096

Hospital & facility affiliations

  • Concord Hospital Hospital, Concord, NH, CCN 300001
  • Concord Hospital- Laconia Hospital, Laconia, NH, CCN 300005

Merit-based Incentive Payment System (MIPS)

Final score
89 of 100Reported as apm
Quality
73.23
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0391NHMDOccupational Therapist
0391PNHMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Hospital, Inc. CurrentSince Jan 1, 2021 Accepting new patients
Concord Hospital, Inc. CurrentSince Jan 1, 2021 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Sep 1, 2015 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Sep 1, 2015 Accepting new patients

Locations

246 Pleasant St
Concord, NH 03301
Phone (603) 224-1223

250 Pleasant St
Concord, NH 03301
Phone (603) 225-2711

253 Pleasant St
Concord, NH 03301
Phone (603) 226-2200

60 Commercial St
Ste 404
Concord, NH 03301
Phone (603) 228-1763

246 Pleasant St
Ste 210
Concord, NH 03301
Phone (603) 224-5200

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

Organizations & group practices 5

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1306882881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCIAL ST",
            "address_2": "SUITE 404",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033015071",
            "telephone_number": "603-228-1763",
            "fax_number": "603-228-7088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 COMMERCIAL ST",
            "address_2": "SUITE 404",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033015071",
            "telephone_number": "603-228-1763",
            "fax_number": "603-228-7088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHWELL",
        "first_name": "MARCY",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NH",
            "license": "0391P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30332153",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NH

Sources for this page

Verify at the official NPI Registry.