Leroy Southmayd III, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

17164 Issued in OK

Practice address

1202 W Wilshire Blvd
Oklahoma City, OK 73116-6109

Phone

(405) 823-3073

NPI assigned

Mar 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lsouthmayd9384@direct.integrisok.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healogics Specialty Physicians of Oklahoma, PLLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Lawton, OK
  • NPI 1144625740
  Medicare reassignment NPD
• Integris Ambulatory Care Corporation

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1750333936
  Medicare reassignment NPD

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583625600000",
    "number": "1851351969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 W WILSHIRE BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731166109",
            "telephone_number": "405-823-3073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 W WILSHIRE BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731166109",
            "telephone_number": "405-823-3073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHMAYD",
        "first_name": "LEROY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2020-03-08",
        "certification_date": "2020-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OK",
            "license": "17164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100219420B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Oklahoma Treatment Services, Inc
• Southern Oklahoma Treatment Services, Inc.
• Southern Plains Medical Center Inc
• Southern Smiles Dental PC
• Southerncare, Inc
• Southpointe Dental PLLC
• Southpointe Family Dentistry PLLC Dba Westmoore Family Dentistry
• Southridge Dental Arts PLLC
• Southside Urology Clinic, P.C.
• Southside Urology Clinic, P.C.

• Nephrology Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Nephrology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.