Sog Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SOG SURGERY CENTER LLC

Practice address

1211 S Gloster St Ste B
Tupelo, MS 38801-6535

Phone

(662) 432-1490

NPI assigned

Sep 13, 2018

Last updated

Jun 4, 2020By 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

Thomas Luster

Title

Ceo

Phone

(662) 767-4200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912480070. Details of each certification follow.

• CCN 250170 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 250170

Legal name

SOG SURGERY CENTER LLC

Certification status

Terminated Voluntary: merger or closure, Jan 8, 2021

Provider type (POS)

Hospital – Short-term

Participating since

Jan 7, 2021

Last certification

Jan 7, 2021

Beds

1

Ownership / control type

Private (for profit)

Facility address

1211 S Gloster St, Ste B
Tupelo, MS 38801

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Sog Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Oxford, MS
  • NPI 1871310383

  1355687864

  Same PAC ID

Listed as

Sog Surgery Center LLCCCN 25C0001098

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1912480070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 S GLOSTER ST STE B",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016548",
            "telephone_number": "662-432-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 S GLOSTER ST STE B",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016535",
            "telephone_number": "662-432-1490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1211 S Gloster St",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388016535",
            "country_code": "US",
            "telephone_number": "417-889-2040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOG SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-13",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "LUSTER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-767-4200"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valeda Smith
• Jacob Allen Smithey, MD
• Shanta Sneed, LCSW
• Jasmine Snow, M.S.
• Sog Physical Therapy
• Elizabeth Sojourner, PHARMD
• Sondra Bennett Pmhnp-BC LLC
• Hannah Soni, DO
• Southern Caregivers of Tupelo/Oxford, LLC
• Southern Mobility Specialists Inc (Southern Mobility Specialists)

• Ambulatory Surgical Clinic/Center in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Ambulatory Surgical Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.