NPIMap

Organization Active NPI

Southern Ohio Surgical Associates, Inc.

  • Surgery Physician
  • Portsmouth, OH
National Provider Identifier
1528050945
Registry record updated Jan 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
35-84596 Issued in OH
Legal business name
SOUTHERN OHIO SURGICAL ASSOCIATES, INC.
Practice address
1711 27TH St
Braunlin BLDG, Suite 306
Portsmouth, OH 45662-2638
Phone
(740) 353-8661
Fax
(740) 354-3254
NPI assigned
Aug 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2011

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

Authorized official

Name
Thomas L Khoury, M.D.NPI 1306838719
Title
President
Phone
(740) 353-8661

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X 35-06-5158-K OH
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X 35-84596 OH Primary
Surgical Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363AS0400X 50-00-1711 OH

Addresses

Primary practice location

1711 27TH St
Braunlin BLDG, Suite 306
Portsmouth, OH 45662-2638

Mailing address

1711 27TH St
Braunlin BLDG, Suite 306
Portsmouth, OH 45662-2638
Phone (740) 353-8661

Other identifiers 2

IdentifierTypeStateIssuer
0317875MedicaidOH
65907073MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040218000763 OH Part B Supplier - Clinic/Group Practice 4688569676 Receives reassigned benefits from 3 practitioners
Practice locations: Portsmouth, OH

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.612

Practitioners & affiliated clinicians

Practitioners 3

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": "1124668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296086400000",
    "number": "1528050945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 27TH ST",
            "address_2": "BRAUNLIN BLDG, SUITE 306",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456622638",
            "telephone_number": "740-353-8661",
            "fax_number": "740-354-3254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 27TH ST",
            "address_2": "BRAUNLIN BLDG, SUITE 306",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456622638",
            "telephone_number": "740-353-8661",
            "fax_number": "740-354-3254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OHIO SURGICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-22",
        "last_updated": "2011-01-27",
        "status": "A",
        "authorized_official_last_name": "KHOURY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "740-353-8661",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "OH",
            "license": "35-06-5158-K",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "OH",
            "license": "35-84596",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50-00-1711",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0317875",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65907073",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.