Organization Active NPI

Sotolongo Clinic, PA

  • Podiatrist
  • Ridgeland, MS
National Provider Identifier
1679826945
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
SOTOLONGO CLINIC, PA
Practice address
731 S Pear Orchard Rd
Suite 7
Ridgeland, MS 39157-4800
Phone
(601) 206-9101
NPI assigned
Oct 23, 2012
Organization subpart
Yes
Parent organization
SOTOLONGO CLINIC, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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

Authorized official

Name
Dr. Rose M. Sotolongo, DPMNPI 1790779858
Title
Owner
Phone
(601) 206-9101

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

731 S Pear Orchard Rd
Suite 7
Ridgeland, MS 39157-4800

Mailing address

731 S Pear Orchard Rd Ste 7
Ridgeland, MS 39157-4839
Phone (601) 206-9101

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230228000510 MS Part B Supplier - Clinic/Group Practice 3072986751 Receives reassigned benefits from 1 practitioner
Practice locations: Ridgeland, MS

National Provider Directory

National Provider Directory
Part of
Sotolongo Clinic PA

Practitioners & affiliated clinicians

Practitioners 1

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": "1350950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1679826945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 S PEAR ORCHARD RD STE 7",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574839",
            "telephone_number": "601-206-9101",
            "fax_number": "601-206-9102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 S PEAR ORCHARD RD",
            "address_2": "SUITE 7",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391574800",
            "telephone_number": "601-206-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOTOLONGO CLINIC, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOTOLONGO CLINIC, PA",
        "enumeration_date": "2012-10-23",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "SOTOLONGO",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-206-9101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; 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.