SOUTHERN MEDICAL CORPORATION PC (NPI# 1093901480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093901480 |
| Entity Type | Organization |
| Organization Name | SOUTHERN MEDICAL CORPORATION PC |
| Practice Address |
6433 E Washington St Suite 125 Indianapolis IN 46219-6677 |
| Practice Telephone | 3179231274 |
| Practice Fax Number | 3179244436 |
| Mailing Telephone | 3179231274 |
| Mailing Fax Number | 3179244436 |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2015-12-07 |
| Authorized Official Name | DR. CHERYLE DAWN SOUTHERN (PHYSICIAN) |
| Authorized Official Telephone | 3179231274 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 01033547A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100237790A | 05 | |
| IN | RAILROAD MEDICARE | 110014372 | 01 |
| IN | ANTHEM | 000000086109 | 01 |
| Street Address |
6433 E WASHINGTON ST SUITE 125 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46219-6677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497236814 | L.a.s.e.r. Project Inc | Case Management | 6433 E Washington St, Indianapolis, IN 46219-6677 | 2018-08-23 |
| 1366742371 | East Indy Dental Care, LLC | Dentist | 6433 E Washington St, Suite 105, Indianapolis, IN 46219-6677 | 2010-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518571157 | Kara Kathryn Berning | Dietitian, Registered | 2040 N. Shadeland Ave, Suite 130, Indianapolis, IN 46219 | 2020-09-01 |
| 1780223750 | Erin Cannon | Specialist | 1543 N Post Rd, Indianapolis, IN 46219 | 2019-12-23 |
| 1073151239 | Tanicka Elizabeth Word | Behavior Technician | 6635 E 21st Street, West Building, Indianapolis, IN 46219 | 2019-12-18 |
| 1790322527 | Arlington Westend Dental LLC | Dentist | 5900 E 10th St, Indianapolis, IN 46219 | 2019-11-27 |
| 1336645985 | Lynell Westbrook Gates | Counselor | 1311 N Arlington Ave Ste 102, Indianapolis, IN 46219 | 2018-04-03 |
| 1861991689 | Comfort Dental LLC | Clinic/Center | 8151 E 21st St., Indianapolis, Indianapolis, IN 46219 | 2018-02-07 |
| 1467811570 | Fresenius Medical Care Indiana, LLC | Clinic/Center | 6701 E 21st St, Indianapolis, IN 46219 | 2016-02-17 |
| 1992197289 | Casey Baker | Physician Assistant | 1500 N Ritter Ave (medical Associates, LLP), Indianapolis, IN 46219 | 2015-02-24 |
| 1811398407 | Adam Romesser | Pharmacist | 8907 E. 10th St., Indianapolis, IN 46219 | 2014-09-15 |
| 1225448673 | Justin Stauffer | Pharmacist | 5903 E Pleasant Run Parkway North Dr, Indianapolis, IN 46219 | 2014-05-06 |
| Find all providers in zip 46219 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386280923 | Spencer Wellness Centre LLC | Internal Medicine | 7202 E 71st St, Indianapolis, IN 46256-1904 | 2019-11-19 |
| 1982245593 | Melvin Jay Prince | Internal Medicine | Gennesaret Free Clinic 615 N Alabama St, Suite 136, Indianapolis, IN 46204 | 2019-10-04 |
| 1699321307 | Medical Consultants of Central Indiana LLC | Internal Medicine | 5252 E 82nd St Ste 300, Indianapolis, IN 46250-5704 | 2019-08-18 |
| 1881167997 | Jara Lynn Southerland | Internal Medicine | 10122 E 10th St Ste 220, Indianapolis, IN 46229-2664 | 2019-01-10 |
| 1306330980 | Brian Paul Wynia | Internal Medicine | 5122 Millwright Ct, Indianapolis, IN 46254-4786 | 2018-06-18 |
| 1053848457 | Hasan Rana | Internal Medicine | 8081 Township Line Rd Ste 202, Indianapolis, IN 46260-2189 | 2017-05-16 |
| 1194275669 | Lucina Treatment Center, LLC | Internal Medicine | 8140 Castleton Rd, Indianapolis, IN 46250 | 2016-10-09 |
| 1225581168 | Stepping Stone Institute, LLC | Internal Medicine | 5785 N Delaware St, Indianapolis, IN 46220-2527 | 2016-07-27 |
| 1598118572 | Jennifer Clark | Internal Medicine | 1120 W. Michigan Street Gatch Hall Cl 630, Indianapolis, IN 46204 | 2016-07-14 |
| 1275985632 | Nour Hamade | Internal Medicine | 702 Rotary Circle, Suite 225, Indianapolis, IN 46202 | 2016-07-11 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46219 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.