Active NPI
Kristian Jorgensen, DO
- Family Medicine Physician
- Columbia, SC
National Provider Identifier
1033969340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- LL91509
- Practice address
- 3209 Colonial Dr
Columbia, SC 29203-6930 - Phone
- (803) 434-7399
- NPI assigned
- Mar 27, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | LL91509 | SC | Primary |
Addresses
Primary practice location
3209 Colonial Dr
Columbia, SC 29203-6930
Mailing address
3209 Colonial Dr
Columbia, SC 29203-6930
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240919004165 | SC | Order and Referring Only - Family Practice | 5698216497 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721088000000",
"number": "1033969340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3209 COLONIAL DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292036930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3209 COLONIAL DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292036930",
"telephone_number": "803-434-7399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORGENSEN",
"first_name": "KRISTIAN",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-27",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "LL91509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.