James William Southam, NP-C, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

201906644NP-PP Issued in OR

Practice address

1740 NW Goetz St
Roseburg, OR 97471-1613

Phone

(541) 640-7625

NPI assigned

Nov 25, 2019

Last updated

Jan 24, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Icco LLCGroup PAC ID 1355406729, 133 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Icco, LLC

  dba BestMed

  • Urgent Care Clinic/Center
  • Eugene, OR
  • NPI 1407004757
  Medicare reassignment Care Compare group NPD
• Icco LLC

  dba BestMed

  • Rural Health Clinic/Center
  • Florence, OR
  • NPI 1740896547
  NPD
• Icco, LLC

  dba Veneta Medical Clinic

  • Family Medicine Physician
  • Veneta, OR
  • NPI 1518990621
  NPD

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

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1598301582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 HIGH ST STE 224",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013238",
            "telephone_number": "541-500-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 NW GOETZ ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974711613",
            "telephone_number": "541-640-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHAM",
        "first_name": "JAMES",
        "middle_name": "WILLIAM",
        "credential": "NP-C, FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-25",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201906644NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Agatha Song
• Sonus-USA, Inc.
• Shawn Sorensen, CSWA, QMHP, CADCIII
• Thomas Wayne Sorrells Jr., CSWA
• Soul Sessions Psychotherapy LLC
• Kelly Anne Southern, MSW
• Libby Sparks, CADC-I
• Spectrum Prosthetics and Orthotics, LLC
• Kimberlly B Speed, MSW
• Emma Speer, RN

• Family Nurse Practitioner in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.