SOUTHERN GASTROENTEROLOGY ASSOCIATES PC
NPI 1376659870
Specialist in South Boston, VA

Q: What is Southern Gastroenterology Associates PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since August 21, 2006

1129 N MAIN ST STE G, SOUTH BOSTON, VA 24592(434) 572-8196(434) 572-8341 Get Directions Write a Review

NPPES record last updated: January 7, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jan 7, 2022, Nov 18, 2021 (2 updates tracked since 2021).

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About Southern Gastroenterology Associates Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN GASTROENTEROLOGY ASSOCIATES PC (NPI 1376659870) is a healthcare organization registered as a specialist in South Boston, Virginia and active in the NPI registry since August 2006. The organization maintains a secondary practice location in South Boston and lists Nicole Palmer, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1376659870

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameSOUTHERN GASTROENTEROLOGY ASSOCIATES PC

Location Address1129 N MAIN ST STE GSouth Boston, VA 24592-2547

Mailing Address1129 N Main St Ste GSouth Boston, VA 24592-2547 · (434) 572-8196 · Fax (434) 572-8341

Phone(434) 572-8196

Fax(434) 572-8341

Organization SubpartNo

Authorized OfficialNicole PalmerPractice Manager · (434) 572-8196

Enumeration DateAugust 21, 2006

Last NPPES UpdateJanuary 7, 20222 updates tracked since enumeration

NPPES CertifiedJanuary 7, 2022

✔ NPI 1376659870 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

1129 N MAIN ST STE G, South Boston, VA 24592

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Secondary Practice Location 1

Location 12232 Wilborn AveSouth Boston, VA 24592-1662 · Phone (434) 572-8196 · Fax (434) 572-4549

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southern Gastroenterology Associates Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 5 clinicians reassign Medicare billing to Southern Gastroenterology Associates PC, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Seth Gupton, NP

Gastroenterology

NPI 1437815032

1129 N MAIN ST STE G
South Boston, VA 24592

(434) 572-8196

✔ PECOS✔ Accepts MedicareSame address

Suresh Jayatilaka, M.D.

Gastroenterology

NPI 1265557953

1129 N MAIN ST STE G
South Boston, VA 24592

(434) 572-8196

✔ PECOS✔ Accepts MedicareSame address

Bakul Patel

Gastroenterology

NPI 1912914102

1129 N MAIN ST STE G
South Boston, VA 24592

(434) 572-8196

✔ PECOS✔ Accepts MedicareSame address

Pablo Souza, M.D.

Pathology

NPI 1326244740

2204 WILBORN AVE
South Boston, VA 24592

(434) 517-3229

✔ PECOS✔ Accepts Medicare0.5 mi

Whitney Myers, FNP

Nurse Practitioner

NPI 1962744508

2232 WILBORN AVE
South Boston, VA 24592

(276) 340-2240

✔ PECOS✔ Accepts Medicare1.2 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Gastroenterology Associates PC's NPI number?

The NPI number for Southern Gastroenterology Associates PC is 1376659870. It was assigned to this organization in the NPPES registry on August 21, 2006.

Where is Southern Gastroenterology Associates PC located?

Southern Gastroenterology Associates PC is located at 1129 N Main St Ste G, South Boston, VA 24592. The listed phone number is (434) 572-8196.

What is Southern Gastroenterology Associates PC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Southern Gastroenterology Associates PC enrolled in Medicare?

Yes. Southern Gastroenterology Associates PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Gastroenterology Associates PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 3 Medicare specialties reassign their Medicare billing to Southern Gastroenterology Associates PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Gastroenterology (3), Nurse Practitioner (1) and Pathology (1). Of these, 3 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Southern Gastroenterology Associates PC was last updated on January 7, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.