NPIMap

Individual provider Active NPI

Tiffany Nicole Puckett, APRN

  • Family Nurse Practitioner
  • Columbia, SC
National Provider Identifier
1073073896
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
22704 Issued in SC
Practice address
111 Doctor Cir
Columbia, SC 29203-6502
Phone
(800) 491-0909
NPI assigned
Mar 20, 2019
Last updated
Nov 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 22704 SC
Family Nurse Practitioner 363LF0000X 22704 SC Primary

Addresses

Primary practice location

111 Doctor Cir
Columbia, SC 29203-6502

Mailing address

111 Doctor Cir
Columbia, SC 29203-6502
Phone (800) 491-0909

Other identifiers 1

IdentifierTypeStateIssuer
NP5810MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190429002644 SC Practitioner - Nurse Practitioner 7416299102 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Carolina School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, 1,060 clinicians
SC House Calls IncGroup PAC ID 6800994807, 445 clinicians

Practice addresses (Care Compare)

101 E Wood St
Spartanburg, SC 29303-3040
Phone (864) 560-7025

1053 Ctr St
West Columbia, SC 29169-6749
Phone (800) 491-0909

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SC House Calls Inc CurrentSince Feb 23, 2021 Accepting new patients
SC House Calls Inc CurrentSince Feb 23, 2021 Accepting new patients
Spartanburg Medical Center CurrentSince Apr 1, 2019 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center CurrentSince Apr 1, 2019 Accepting new patients
Spartanburg Medical Center Past Accepting new patients

Locations

111 Doctor Cir
Columbia, SC 29203
Phone (803) 730-8910

1624 Main St
Columbia, SC 29201
Phone (803) 454-0365

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

1053 Center St
West Columbia, SC 29169
Phone (803) 454-0365

Interoperability endpoints

  • Direct secure messaging: tiffany.puckett.1@7602.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1073073896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DOCTOR CIR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036502",
            "telephone_number": "800-491-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DOCTOR CIR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036502",
            "telephone_number": "800-491-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "TIFFANY",
        "middle_name": "NICOLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-20",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "22704",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "22704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP5810",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.