Southern Obstetric & Gyneco Associates

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

042005236 Issued in IL

Legal business name

SOUTHERN OBSTETRIC & GYNECO ASSOCIATES

Doing business as

Southern OB/GYN

Practice address

1201 Ricker Rd
Salem, IL 62881-4263

Phone

(618) 526-2209

Fax

(618) 526-7372

NPI assigned

Jul 3, 2012

Last updated

Jul 3, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Anne E Doll-Pollard, M.D.NPI 1881652626

Title

President

Phone

(618) 526-2209

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southern OB/GYN Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Southern Obstetric & Gyneco Associates

  dba Southern OB/GYN

  • Obstetrics & Gynecology Physician
  • Greenville, IL
  • NPI 1205199452

  O20041130000387

  Same enrollment
• Southern Obstetric & Gyneco Associates

  dba Southern OB/GYN

  • Obstetrics & Gynecology Physician
  • Breese, IL
  • NPI 1467419804

  O20041130000387

  Same enrollment
• Southern Obstetric & Gyneco Associates

  dba Southern OB/GYN-Highland

  • Obstetrics & Gynecology Physician
  • Highland, IL
  • NPI 1962793687

  O20041130000387

  Same enrollment

Locations

Practitioners 1

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.

• Anne Doll-Pollard, M.D.

  • Obstetrics & Gynecology Physician
  • Breese, IL
  • NPI 1881652626
  NPD Authorized official

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

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341273600000",
    "number": "1881958981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9447 HOLY CROSS LN",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303510",
            "telephone_number": "618-526-2209",
            "fax_number": "618-526-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 RICKER RD",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628814263",
            "telephone_number": "618-526-2209",
            "fax_number": "618-526-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OBSTETRIC & GYNECO ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-03",
        "last_updated": "2012-07-03",
        "status": "A",
        "authorized_official_last_name": "DOLL-POLLARD",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-526-2209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "042005236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COPORATE LICENSE",
            "identifier": "042005236",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keith Shaw, PT
• Katie Shelton
• Michael Smith, PT
• Taryn Lee Smith, SSP
• Southern Illinois Healthcare Foundation, Inc. (Salem Medical Center)
• Lisa Marie Starwalt
• Jason Kenneth Steinkamp, RPH
• Evonne Lanae Stephenson, M.S., LCPC
• James B Stiehl, MD
• Palaniappan Suppiah, MD

• Obstetrics & Gynecology Physician in Salem, IL
• Providers in Salem, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; 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.