Southern Cardiovascular PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

SOUTHERN CARDIOVASCULAR PLLC

Practice address

6401 Poplar Ave Ste 410
Memphis, TN 38119

Phone

(901) 259-2718

Fax

(901) 259-1123

NPI assigned

Jul 22, 2008

Last updated

Aug 15, 2018By 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. Jonathan Joe Ellichman, M.D.NPI 1073538823

Title

President

Phone

(901) 259-2718

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN, AR2 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

Practitioners 3

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.

• Jonathan J Ellichman, M.D.

  • Vascular Surgery Physician
  • Memphis, TN
  • NPI 1073538823

  AR

  Medicare reassignment Care Compare group Authorized official
• Jennifer L Kirby, FNP

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1598058356
  Medicare reassignment Care Compare group NPD
• Gary Marc Mantell, D.P.M.

  • Primary Podiatric Medicine Podiatrist
  • Memphis, TN
  • NPI 1750305892
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534291200000",
    "number": "1447415104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1135",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380271135",
            "telephone_number": "901-259-2718",
            "fax_number": "901-259-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 POPLAR AVE STE 410",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38119",
            "telephone_number": "901-259-2718",
            "fax_number": "901-259-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CARDIOVASCULAR PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2018-08-15",
        "status": "A",
        "authorized_official_last_name": "ELLICHMAN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "JOE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-259-2718",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1526038",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Memphis, TN
• Providers in Memphis, TN by specialty
• Multi-Specialty Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; 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.