Individual provider Active NPI

Brandon Heath Kilgore, MD

  • Psychiatry Physician
  • Columbia, SC
National Provider Identifier
1023158508
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
61328 Issued in SC
Practice address
3555 Harden Street Ext Ste 141
Columbia, SC 29203
Phone
(803) 434-4300
Fax
(803) 434-4351
NPI assigned
Feb 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 23447 OK
Psychiatry Physician 2084P0800X 61328 SC Primary

Addresses

Primary practice location

3555 Harden Street Ext Ste 141
Columbia, SC 29203

Mailing address

PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320

Other practice location 1

4502 E 41st St
2F15
Tulsa, OK 74135-2536
Phone (918) 660-3518

Other identifiers 2

IdentifierTypeStateIssuer
200199860AMedicaidOK
613287MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190503000571 SC Practitioner - Psychiatry 5890853725

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
61328SCMDSchool Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Edmond General Surgery LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1023158508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904",
            "telephone_number": "803-296-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 HARDEN STREET EXT STE 141",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-4300",
            "fax_number": "803-434-4351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4502 E 41st St",
            "address_2": "2F15",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741352536",
            "country_code": "US",
            "telephone_number": "918-660-3518",
            "fax_number": "918-660-3517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KILGORE",
        "first_name": "BRANDON",
        "middle_name": "HEATH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "23447",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "61328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200199860A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "613287",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.