Southeastern Medical Associates, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTHEASTERN MEDICAL ASSOCIATES, LLC

Practice address

1795 Dr Frank Gaston Blvd
Rock Hill, SC 29732-1190

Phone

(839) 400-4440

NPI assigned

Jan 17, 2024

Last updated

Jan 17, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Javed Firoz Patka, D.O.NPI 1033557806

Title

Owner

Phone

(839) 400-4440

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

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.

• Javed Firoz Patka, D.O.

  • Internal Medicine Physician
  • Fort Mill, SC
  • NPI 1033557806
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1316708480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 HIGHWAY 160 W STE 101-239",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088009",
            "telephone_number": "839-400-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 DR FRANK GASTON BLVD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321190",
            "telephone_number": "839-400-4440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2260 Vista Rd",
            "address_purpose": "LOCATION",
            "city": "Fort MIll",
            "state": "SC",
            "postal_code": "29732",
            "country_code": "US",
            "telephone_number": "839-400-4440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHEASTERN MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-14",
        "status": "A",
        "authorized_official_last_name": "PATKA",
        "authorized_official_first_name": "JAVED",
        "authorized_official_middle_name": "FIROZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "839-400-4440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.