Envision Wellness Medical Group LLC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

Legal business name

ENVISION WELLNESS MEDICAL GROUP LLC

Practice address

4100 N Main St Ste 101
Columbia, SC 29203-5800

Phone

(803) 256-0101

Fax

(800) 854-3497

NPI assigned

May 12, 2020

Organization subpart

No

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

Authorized official

Name

Ayanna Swinton Jamison, MD

Title

Dr/Owner

Phone

(803) 256-0101

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Tax ID family

Envision Wellness Medical Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Envision Wellness Medical Group LLC

  • Psychiatry Physician
  • Columbia, SC
  • NPI 1710690912
  NPD tax ID

Practitioners 2

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

• Micheal G Gore, MSSA, MSW, LISW

  • Clinical Social Worker
  • Sumter, SC
  • NPI 1427412162
  Medicare reassignment NPD
• Ayanna Swinton Jamison, M.D.

  • Child & Adolescent Psychiatry Physician
  • Columbia, SC
  • NPI 1053359851
  Medicare reassignment NPD

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

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1043832157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 N MAIN ST STE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292035800",
            "telephone_number": "803-256-0101",
            "fax_number": "800-854-3497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 N MAIN ST STE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292035800",
            "telephone_number": "803-256-0101",
            "fax_number": "800-854-3497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION WELLNESS MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "JAMISON",
        "authorized_official_first_name": "AYANNA",
        "authorized_official_middle_name": "SWINTON",
        "authorized_official_title_or_position": "DR/OWNER",
        "authorized_official_telephone_number": "803-256-0101",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "envisionmedicalgroup@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4100 N Main St Ste 101",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292035800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ennoble Hospice SC LLC
• Towanna Shanett-Lance Enoch, NP-C
• Manuel Hipolito Enriquez, M.D.
• Envision Therapy Services, LLC
• Envision Wellness Medical Group
• Envision Wellness Medical Group LLC
• David Alan Eoute Jr., MSP, SLP-CFY
• Joanne B Epley, RPH
• Lindsay Benvenuto Eppehimer, APRN
• Maria N Eppig, D.O.

• Child & Adolescent Psychiatry Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Child & Adolescent Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; 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.