NPIMap

Organization Active NPI

Southern Group Anesthesia PLLC

  • Anesthesiology Physician
  • Katy, TX
National Provider Identifier
1720628936
Registry record updated Apr 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SOUTHERN GROUP ANESTHESIA PLLC
Practice address
1259 FM 1463 Rd Ste 500
Katy, TX 77494-5470
Phone
(361) 237-1072
NPI assigned
Jan 15, 2020
Last updated
Apr 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2020

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

Authorized official

Name
Renata Pereira
Title
Billing Manager
Phone
(979) 549-1131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

1259 FM 1463 Rd Ste 500
Katy, TX 77494-5470

Mailing address

801 FM 1463 Rd Ste 200
Katy, TX 77494-7925
Phone (361) 237-1072

Other names 1

  • Southern Group Anesthesia PLLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200501000875 TX Part B Supplier - Clinic/Group Practice 6204266489 Receives reassigned benefits from 50 practitioners
Practice locations: Katy, TX

National Provider Directory

National Provider Directory

Locations

1259 FM 1463 Rd
Ste 500
Katy, TX 77494
Phone (361) 237-1072

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586304000000",
    "number": "1720628936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 FM 1463 RD STE 200",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774947925",
            "telephone_number": "361-237-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1259 FM 1463 RD STE 500",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774945470",
            "telephone_number": "361-237-1072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GROUP ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A",
        "authorized_official_last_name": "PEREIRA",
        "authorized_official_first_name": "RENATA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "979-549-1131"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Group Anesthesia PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Katy, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; 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.