Southern Gastroenterology Associates PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTHERN GASTROENTEROLOGY ASSOCIATES PC

Practice address

1129 N Main St Ste G
South Boston, VA 24592-2547

Phone

(434) 572-8196

Fax

(434) 572-8341

NPI assigned

Aug 21, 2006

Organization subpart

No

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

Authorized official

Name

Nicole Palmer

Title

Practice Manager

Phone

(434) 572-8196

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, NC2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18834/brand/1/csg/1/fhir/r4

Practitioners 5

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

• Seth Gupton, NP

  • Family Nurse Practitioner
  • South Boston, VA
  • NPI 1437815032
  Medicare reassignment Care Compare group NPD
• Suresh Gehan Jayatilaka, M.D.

  • Gastroenterology Physician
  • South Boston, VA
  • NPI 1265557953

  NC

  Medicare reassignment Care Compare group NPD
• Whitney A Myers, FNP

  • Family Nurse Practitioner
  • South Boston, VA
  • NPI 1962744508
  Medicare reassignment Care Compare group NPD
• Bakul Kumar Patel

  • Gastroenterology Physician
  • South Boston, VA
  • NPI 1912914102
  Medicare reassignment Care Compare group NPD
• Pablo Cesar Souza, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • South Boston, VA
  • NPI 1326244740
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641513600000",
    "number": "1376659870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 N MAIN ST STE G",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245922547",
            "telephone_number": "434-572-8196",
            "fax_number": "434-572-8341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 N MAIN ST STE G",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245922547",
            "telephone_number": "434-572-8196",
            "fax_number": "434-572-8341"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2232 Wilborn Ave",
            "address_purpose": "LOCATION",
            "city": "South Boston",
            "state": "VA",
            "postal_code": "245921662",
            "country_code": "US",
            "telephone_number": "434-572-8196",
            "fax_number": "434-572-4549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN GASTROENTEROLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "434-572-8196"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Boston Behavioral Health LLC (Hopewood Recovery Center)
• South Boston Health & Rehab Center, LLC
• South Boston Manor, LLC
• South Boston Pediatrics, PC
• South Boston Transportation LLC
• Southern Gastroenterology Endoscopy Center, P.C.
• Southside Behavioral Health - Brandon Home
• Southside Emergency Physicians PC
• Southside Medical Associates P.C
• Southside Wound Care PLLC

• Specialist in South Boston, VA
• Providers in South Boston, VA by specialty
• Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2022; 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.