Individual provider Active NPI

Vida Gholami Yousefian, MD

  • Psychiatry Physician
  • Columbia, SC
National Provider Identifier
1043835879
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
LL84149 Issued in SC
Practice address
Prisma Health Medical Group Psychiatry
15 Medical Park, Ste 141
Columbia, SC 29203
Phone
(803) 434-1433
Fax
(803) 434-4062
NPI assigned
Jun 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X LL84149 SC Primary

Addresses

Primary practice location

Prisma Health Medical Group Psychiatry
15 Medical Park, Ste 141
Columbia, SC 29203

Mailing address

Prisma Health Medical Group Psychiatry
15 Medical Park, Ste 141
Columbia, SC 29203
Phone (803) 434-1433

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
I20240815001330 SC Practitioner - Psychiatry 0446798953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of South Carolina School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Carolina Dept of Mental Health Accounting OfficeGroup PAC ID 9032021175, 226 clinicians

Practice addresses (Care Compare)

2200 Harden St
Columbia, SC 29203-7107
Phone (803) 898-8405

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL84149SCMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Carolina Dept of Mental Health Accounting Office Psychiatry CurrentSince May 9, 2024 Accepting new patients
South Carolina Dept of Mental Health Accounting Office Psychiatry Current Accepting new patients
South Carolina Dept of Mental Health Accounting Office CurrentSince May 9, 2024 Accepting new patients

Locations

7901 Farrow Rd
Columbia, SC 29203
Phone (803) 734-7846

220 Faison Dr
Columbia, SC 29203
Phone (803) 898-1662

2200 Harden St
Columbia, SC 29203
Phone (803) 737-5300

2414 Bull St
Columbia, SC 29201
Phone (803) 898-2461

610 Faison Dr
Columbia, SC 29203
Phone (803) 898-8523

Interoperability endpoints

  • Direct secure messaging: vyousefian385603@direct.ghs.myhfn.org

Organizations & group practices 3

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": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1043835879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PRISMA HEALTH MEDICAL GROUP PSYCHIATRY",
            "address_2": "15 MEDICAL PARK, STE 141",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-1433",
            "fax_number": "803-434-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PRISMA HEALTH MEDICAL GROUP PSYCHIATRY",
            "address_2": "15 MEDICAL PARK, STE 141",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-1433",
            "fax_number": "803-434-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUSEFIAN",
        "first_name": "VIDA",
        "middle_name": "GHOLAMI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "LL84149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.