NPIMap

Organization Active NPI

Palmetto Health University of South Carolina Medical Group

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1053817320
Registry record updated Apr 4, 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
3600 Forest Dr FL 3
Columbia, SC 29204-4052
Phone
(803) 749-5101
Fax
(803) 933-3045
NPI assigned
Apr 4, 2018
Last updated
Apr 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 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 Physician 207Q00000X SC Primary

Addresses

Primary practice location

3600 Forest Dr FL 3
Columbia, SC 29204-4052

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 14

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

View all 14

Locations

3600 Forest Dr
Fl 3
Columbia, SC 29204
Phone (803) 749-5101

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522800000000",
    "number": "1053817320",
    "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",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 FOREST DR FL 3",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292044052",
            "telephone_number": "803-749-5101",
            "fax_number": "803-933-3045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO HEALTH UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-04",
        "last_updated": "2018-04-04",
        "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": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP7530",
            "state": "SC"
        }
    ],
    "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 Apr 4, 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.