Kirby D Southall, M.D.
Individual provider Active NPI Family Medicine Physician · Sutherland, VA
NPI 1750358750 · NPPES record last updated Feb 17, 2009
Key facts
- NPI
- 1750358750
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0101039352 (VA)
- Practice address
- 5609 Claiborne Rd
Sutherland, VA 23885-9303 - Phone
- (804) 265-5211
- Fax
- (804) 265-2707
- NPI assigned
- Mar 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 31
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Virginia School of Medicine, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sutherland Family Practice Inc
Practice addresses (Care Compare)
5609 Claiborne Rd
Sutherland, VA 23885-9303
Phone (804) 265-5211
Hospital & facility affiliations
- Amedisys Home Health
- At Home Care
- Southside Regional Home Health
- James River Home Health Agency
- Enhabit Home Health
- Bon Secours Southside Medical Center
- Bon Secours St Francis Medical Center
- John Randolph Medical Center
- Bon Secours St Marys Hospital
- Medical College of Virginia Hospitals
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 19 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 11 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100913000546 | VA | Practitioner - Family Practice | 1456496280 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101039352 | VA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sutherland Family Practice Inc. | Family Medicine | Current |
Accepting new patients |
| Frederick Health Hospital Inc | Past | Accepting new patients |
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
- kirby.southall.1@27068.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101039352 | VA | 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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 828665 | Other | VA | OPT CHOICE |
| 100629 | Other | VA | ANTHEM |
| 5697727 | Medicaid | VA | |
| 080642 | Other | VA | QUALCHOICE |
| 45882 | Other | VA | SENTARA |
| 815042 | Other | VA | SOUTHERN HEALTH |
| 5697727 | Other | VA | VA. PREMIER |
| 577244 | Other | VA | AETNA |
Other providers in Sutherland, VA
- Heath A Marshall
- Parker Family Services
- Sarah Parker
- William James Phipps Jr.
- Caleb Donaldson Southall
- Sutherland Family Practice Inc.
- 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 Feb 17, 2009. 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.
- Order and Referring (CMS).
- 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.