SOUTHERN PRIMARY CARE PLLC
NPI 1891083135
Family Medicine in Brookhaven, MS
About Southern Primary Care Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHERN PRIMARY CARE PLLC (NPI 1891083135) is a healthcare organization registered as a family medicine in Brookhaven, Mississippi and active in the NPI registry since July 2011. The organization holds a CLIA Waiver certificate valid through July 7, 2027 and lists Robert K Walker, Owner/president, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
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)
Southern Primary Care Pllc 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 Southern Primary Care PLLC, 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 25D2061911
Southern Primary Care, PLLC · Brookhaven, MSFrequently 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 Primary Care PLLC's NPI number?
The NPI number for Southern Primary Care PLLC is 1891083135. It was assigned to this organization in the NPPES registry on July 20, 2011.
Where is Southern Primary Care PLLC located?
Southern Primary Care PLLC is located at 511 Brookman Dr, Brookhaven, MS 39601. The listed phone number is (601) 833-3800.
What is Southern Primary Care PLLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Southern Primary Care PLLC enrolled in Medicare?
Yes. Southern Primary Care PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southern Primary Care PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Southern Primary Care PLLC. 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 Southern Primary Care PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 25D2061911) is associated with this NPI, valid through July 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Southern Primary Care PLLC accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Southern Primary Care PLLC 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 Southern Primary Care PLLC was last updated on July 20, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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 Primary Care Pllc · NPI 1891083135
Family Medicine organization in Brookhaven, Mississippi. Organization record, active in the CMS NPPES registry since July 20, 2011.
## Identity
- **NPI:** 1891083135 (Entity type: Organization)
- **Enumerated:** July 20, 2011
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Robert Walker, OWNER/PRESIDENT
## Practice location
- **Address:** 511 BROOKMAN DR, Brookhaven, MS 39601-2326
- **Phone:** (601) 833-3800 · **Fax:** (601) 833-3847
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 2 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 20, 2011
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1891083135) · Data from the CMS NPPES public registry.