Sutherland Family Practice Inc.
Organization Active NPI Family Medicine Physician · Sutherland, VA
NPI 1699869487 · NPPES record last updated Sep 18, 2007
Key facts
- NPI
- 1699869487
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SUTHERLAND FAMILY PRACTICE INC.
- Practice address
- 5609 Claiborne Rd
Sutherland, VA 23885-9303 - Phone
- (804) 265-5211
- Fax
- (804) 265-2707
- NPI assigned
- Oct 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Eileen H Simmons, RN
- Title
- Office Manager
- Phone
- (804) 265-5211
Practitioners 5
-
Kirby D Southall, M.D.
-
Sharon Clifton Newton, F.N.P.
-
Joan M Wyatt, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D0231089 | Sutherland Family Practice | Provider-performed microscopy | Nov 17, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040709001022 | VA | Part B Supplier - Clinic/Group Practice | 1153309703 |
Receives reassigned benefits from 4 practitioners Practice locations: Sutherland, VA |
National Provider Directory
Locations
5609 Claiborne Rd
Sutherland, VA 23885
Phone (804) 265-5211
Interoperability endpoints
- https://api.platform.athenahealth.com/27068/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
5609 Claiborne Rd
Sutherland, VA 23885-9303
Mailing address
5609 Claiborne Rd
Sutherland, VA 23885-9303
Phone (804) 265-5211
Other providers in Sutherland, VA
- Parker Family Services
- Sarah Parker
- William James Phipps Jr.
- Caleb Donaldson Southall
- Kirby D Southall
- Sutherland Pharmacy,Inc
All providers in Sutherland, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.