NPIMap

Organization Active NPI

Palmetto Health - University of South Carolina Medical Group

  • Family Medicine Physician
  • Irmo, SC
National Provider Identifier
1033607809
Registry record updated Apr 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP
Practice address
1079 Dutch Fork Rd
Irmo, SC 29063-8725
Phone
(803) 749-8900
NPI assigned
Apr 27, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

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

Authorized official

Name
William D. Anderson III,, MD
Title
Chief Medical Officer
Phone
(803) 545-5005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1079 Dutch Fork Rd
Irmo, SC 29063-8725

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
GP7530MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Palmetto Health - University of South Carolina Medical Group72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1079 Dutch Fork Rd
Irmo, SC 29063
Phone (803) 749-8900

NPI Registry JSON

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524787200000",
    "number": "1033607809",
    "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": "1079 DUTCH FORK RD",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290638725",
            "telephone_number": "803-749-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-27",
        "last_updated": "2018-04-27",
        "status": "A",
        "authorized_official_last_name": "ANDERSON III,",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "803-545-5005",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP7530",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 27, 2018; 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.