NPIMap

Organization Active NPI

CSC Acquisition, LLC

Doing business as Columbia Skin Clinc, LLC

  • Dermatology Physician
  • Irmo, SC
National Provider Identifier
1003861337
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
CSC ACQUISITION, LLC
Doing business as
Columbia Skin Clinc, LLC
Practice address
1 Wellness Blvd Ste 109
Irmo, SC 29063-2872
Phone
(803) 779-7316
Fax
(803) 343-2538
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Authorized official

Name
Greta Zimmerman, D.O,NPI 1811960404
Title
Partner
Phone
(803) 779-7316

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1 Wellness Blvd Ste 109
Irmo, SC 29063-2872

Mailing address

3600 Forest Dr Ste 400
Columbia, SC 29204-4057
Phone (803) 779-7316

Other identifiers 1

IdentifierTypeStateIssuer
7480OtherSCMEDICARE PTAN

Other names 1

  • COLUMBIA SKIN CLINC, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040302000455 SC Part B Supplier - Clinic/Group Practice 2860389160 Receives reassigned benefits from 24 practitioners
2 other NPIs on this enrollment
Practice locations: Camden, SC; Columbia, SC; Lexington, SC

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

7039 Saint Andrews Rd
Columbia, SC 29212
Phone (803) 749-0097

1 Wellness Blvd
Ste 109
Irmo, SC 29063
Phone (803) 749-1111

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1003861337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 FOREST DR STE 400",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292044057",
            "telephone_number": "803-779-7316",
            "fax_number": "803-343-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WELLNESS BLVD STE 109",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632872",
            "telephone_number": "803-779-7316",
            "fax_number": "803-343-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CSC ACQUISITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "GRETA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "803-779-7316",
        "authorized_official_credential": "D.O,"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "7480",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COLUMBIA SKIN CLINC, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COLUMBIA SKIN CLINC, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irmo, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.