NPIMap

Organization Active NPI

Southern Obstetric & Gyneco Associates

  • Obstetrics & Gynecology Physician
  • Breese, IL
National Provider Identifier
1467419804
Registry record updated Mar 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SOUTHERN OBSTETRIC & GYNECO ASSOCIATES
Practice address
9447 Holy Cross LN
Breese, IL 62230-3510
Phone
(618) 526-2209
Fax
(618) 526-7372
NPI assigned
Apr 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2011

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

Authorized official

Name
Anne Elizabeth Doll-Pollard, M.D.NPI 1881652626
Title
President
Phone
(618) 526-2209

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

9447 Holy Cross LN
Breese, IL 62230-3510

Mailing address

9447 Holy Cross LN
Breese, IL 62230-3510
Phone (618) 526-2209

Other identifiers 1

IdentifierTypeStateIssuer
042005236OtherILCORPORATION LICENSE

Other names 1

  • Southern OB/GYN Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041130000387 IL Part B Supplier - Clinic/Group Practice 7315902509 Receives reassigned benefits from 10 practitioners
6 other NPIs on this enrollment
Practice locations: Breese, IL; Greenville, IL; Highland, IL; Salem, IL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

7342 State Route 162
Troy, IL 62294
Phone (618) 343-3722

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299801600000",
    "number": "1467419804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9447 HOLY CROSS LN",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303510",
            "telephone_number": "618-526-2209",
            "fax_number": "618-526-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9447 HOLY CROSS LN",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303510",
            "telephone_number": "618-526-2209",
            "fax_number": "618-526-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OBSTETRIC & GYNECO ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2011-03-11",
        "status": "A",
        "authorized_official_last_name": "DOLL-POLLARD",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-526-2209",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION LICENSE",
            "identifier": "042005236",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Breese, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; 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.