Southside Internal Medicine PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHSIDE INTERNAL MEDICINE PC

Practice address

804 Commerce Blvd
Suite B
Riverdale, GA 30296-7198

Phone

(770) 997-6644

Fax

(770) 997-6630

NPI assigned

Dec 7, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Casimir Okoro, M.DNPI 1508948563

Title

Medical Doctor

Phone

(770) 997-6644

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Casimir Chukwuemeka Okoro, M.D

  • Internal Medicine Physician
  • Riverdale, GA
  • NPI 1508948563
  Medicare reassignment Care Compare group NPD Authorized official
• Maritess Gonzales Thomas, FNP-C

  • Nurse Practitioner
  • Atlanta, GA
  • NPI 1013461425
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1291680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421193600000",
    "number": "1740583194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7384 HIGHWAY 85",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302743453",
            "telephone_number": "770-997-6644",
            "fax_number": "770-997-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 COMMERCE BLVD",
            "address_2": "SUITE B",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302967198",
            "telephone_number": "770-997-6644",
            "fax_number": "770-997-6630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-07",
        "last_updated": "2015-01-14",
        "status": "A",
        "authorized_official_last_name": "OKORO",
        "authorized_official_first_name": "CASIMIR",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "770-997-6644",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000544948J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Regional Health System, Inc
• Southern Regional Medical Center - Prime Healthcare
• Southern Regional Medical Center, Inc
• Southern Regional Medical Center, Inc.
• Southern Regional Physicians Management Group, LLC
• Southside Medical Center, Inc.
• Southside Psychiatric Consultants LLC
• Spectrum Health Services
• Fredne Speights, M.D./C.S.A.
• Ivy N Springer

• Primary Care Clinic/Center in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; 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.