Providence Hospital, LLC

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

HTL820 Issued in SC

Legal business name

PROVIDENCE HOSPITAL, LLC

Doing business as

Providence Health

Practice address

2435 Forest Dr
Columbia, SC 29204-2026

Phone

(803) 256-5300

Fax

(803) 256-5935

NPI assigned

Jun 15, 2005

Last updated

Mar 22, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathy J. Teague

Title

Assistant Vice President, Secretary

Phone

(615) 920-7000

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Providence Health Doing business as

Electronic endpoints 1

Locations

Interoperability endpoints

• Direct secure messaging: providencedonotreply@providence.direct.schiex.state.sc.us

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shayla C Freeman, M.D.

  • Emergency Medicine Physician
  • Florence, SC
  • NPI 1598150971
  NPD (past)
• Paraag Ravi Bhatt, M.D.

  • Diagnostic Radiology Physician
  • Stanford, CA
  • NPI 1134549462
  NPD (past)
• Sean O. Bryant, M.D.

  • Diagnostic Radiology Physician
  • Lakewood, CO
  • NPI 1700897477
  NPD (past)
• Yoel Kim, MD

  • Diagnostic Radiology Physician
  • Lakewood, CO
  • NPI 1871082263
  NPD (past)
• Supriti Paul, MD

  • Otolaryngology Physician
  • Carlsbad, CA
  • NPI 1316063936
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1003811290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000",
            "fax_number": "615-920-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 FOREST DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042026",
            "telephone_number": "803-256-5300",
            "fax_number": "803-256-5935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-15",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "TEAGUE",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "ASSISTANT VICE PRESIDENT, SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SC",
            "license": "ASF058",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "SC",
            "license": "HTL820",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "SC",
            "license": "HTL821",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274472",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429453",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ProvidenceDoNotReply@providence.direct.schiex.state.sc.us",
            "affiliation": "N",
            "address_1": "2435 Forest Dr",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292042026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Providence Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Group Practices LLC (South Carolina Heart Center)
• Providence Health Network LLC (Laurel Imaging Center)
• Providence Health Network, LLC (Columbia Medical Associates)
• Providence Hospital LLC (Hospital Professional Services)
• Providence Hospital Northeast Transitional Care Unit (Providence Northeast TCU)
• Providence Occupational Health Services LLC
• Providence Orthopaedic Group LLC (Moore Orthopaedic Clinic)
• Providence Orthopaedic Group, LLC (Moore Orthopaedic Clinic)
• Providence Orthopedic Group, LLC (Moore Center for Orthopedics)
• Providence Orthopedic Group, LLC (Moore Center for Orthopedics)

• General Acute Care Hospital in Columbia, SC
• Providers in Columbia, SC by specialty
• General Acute Care Hospital in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.