SOUTHSIDE INTERNAL MEDICINE PC
NPI 1740583194
Clinic/Center - Primary Care in Riverdale, GA
About Southside Internal Medicine Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHSIDE INTERNAL MEDICINE PC (NPI 1740583194) is a healthcare organization registered as a primary care in Riverdale, Georgia and active in the NPI registry since December 2010. The organization holds a CLIA Waiver certificate valid through November 16, 2026 and lists Casimir Okoro, Medical Doctor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 3
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Southside Internal Medicine Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Southside Internal Medicine PC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D0980346
Southside Internal Medicine PC · Riverdale, GAFrequently 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 Southside Internal Medicine PC's NPI number?
The NPI number for Southside Internal Medicine PC is 1740583194. It was assigned to this organization in the NPPES registry on December 7, 2010.
Where is Southside Internal Medicine PC located?
Southside Internal Medicine PC is located at 804 Commerce Blvd Suite B, Riverdale, GA 30296. The listed phone number is (770) 997-6644.
What is Southside Internal Medicine PC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Southside Internal Medicine PC enrolled in Medicare?
Yes. Southside Internal Medicine PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southside Internal Medicine PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Southside Internal Medicine PC, in Internal Medicine and Nurse Practitioner. 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. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Southside Internal Medicine PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D0980346) is associated with this NPI, valid through November 16, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Southside Internal Medicine PC accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Southside Internal Medicine PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Southside Internal Medicine PC was last updated on January 14, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Southside Internal Medicine Pc · NPI 1740583194
Primary Care organization in Riverdale, Georgia. Organization record, active in the CMS NPPES registry since December 7, 2010.
## Identity
- **NPI:** 1740583194 (Entity type: Organization)
- **Enumerated:** December 7, 2010
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Casimir Okoro, MEDICAL DOCTOR
## Practice location
- **Address:** 804 COMMERCE BLVD, SUITE B, Riverdale, GA 30296-7198
- **Phone:** (770) 997-6644 · **Fax:** (770) 997-6630
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (1), Nurse Practitioner (1); 2 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 14, 2015
- **Other identifiers:** Medicare PIN 11BDSMZ; Medicare UPIN F59027; Medicaid 000544948J (GA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1740583194) · Data from the CMS NPPES public registry.