SOUTHERN PHYSICIAN GROUP MANAGEMENT LLC
NPI 1770162695
Internal Medicine in Nacogdoches, TX
About Southern Physician Group Management Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHERN PHYSICIAN GROUP MANAGEMENT LLC (NPI 1770162695) is a healthcare organization registered as an internal medicine in Nacogdoches, Texas and active in the NPI registry since April 2021. The organization lists Grant Douglass, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Group Practice 1
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 Physician Group Management Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
47Medicare enrollment records show 47 clinicians reassign Medicare billing to Southern Physician Group Management LLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 6
Nearest to this location (20)
See all 47Source: 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 Physician Group Management LLC's NPI number?
The NPI number for Southern Physician Group Management LLC is 1770162695. It was assigned to this organization in the NPPES registry on April 7, 2021.
Where is Southern Physician Group Management LLC located?
Southern Physician Group Management LLC is located at 1204 N Mound St, Nacogdoches, TX 75961. The listed phone number is (936) 564-4611.
What is Southern Physician Group Management LLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Southern Physician Group Management LLC enrolled in Medicare?
Yes. Southern Physician Group Management LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southern Physician Group Management LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 47 clinicians in 6 Medicare specialties reassign their Medicare billing to Southern Physician Group Management LLC. 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 Nurse Practitioner (13), Internal Medicine (11) and Family Practice (9). Of these, 2 practice 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 Physician Group Management LLC was last updated on July 26, 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.
# Southern Physician Group Management Llc · NPI 1770162695
Internal Medicine organization in Nacogdoches, Texas. Organization record, active in the CMS NPPES registry since April 7, 2021.
## Identity
- **NPI:** 1770162695 (Entity type: Organization)
- **Enumerated:** April 7, 2021
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Grant Douglass, PRESIDENT
## Practice location
- **Address:** 1204 N MOUND ST, Nacogdoches, TX 75961-4027
- **Phone:** (936) 564-4611
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 47 clinicians in 6 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (13), Internal Medicine (11), Family Practice (9); 2 practice within 10 miles; [full list](https://npiprofile.com/npi/1770162695/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 26, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1770162695) · Data from the CMS NPPES public registry.