NPIMap

Individual provider Active NPI

Colleen Christiansen, PA-C

  • Physician Assistant
  • Columbia, SC
National Provider Identifier
1083880850
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3722 Issued in SC
Practice address
3 Richland Medical Park Dr Ste 310
Columbia, SC 29203-6862
Phone
(803) 434-8323
Fax
(803) 434-8326
NPI assigned
May 1, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 004830 NY
Physician Assistant 363A00000X 3722 SC Primary

Addresses

Primary practice location

3 Richland Medical Park Dr Ste 310
Columbia, SC 29203-6862

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

100 Nicolls Rd
HSC room T12 Room 080
Stony Brook, NY 11794-8122
Phone (631) 444-1116

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110106000431 NY Practitioner - Physician Assistant 9739378746 Reassigns benefits to 1 organization
I20210802001809 SC Practitioner - Physician Assistant 9739378746 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1643 NW 136 Ave
Sunrise, FL 33323-2857

3 Richland Medical Park Dr
Suite 310
Columbia, SC 29203-6862

PO Box
Suite 421718
Georgetown, SC 29442

Hospital & facility affiliations

  • Conway Medical Center Hospital, Conway, SC, CCN 420049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
004830NYMDChiropractor
3722SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Georgetown Memorial Hospital CurrentSince Dec 30, 2021 Accepting new patients
Conway Hospital, Inc. Past Accepting new patients

Locations

606 Black River Rd
Georgetown, SC 29440
Phone (843) 527-7000

Organizations & group practices 5

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1083880850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RICHLAND MEDICAL PARK DR STE 310",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036862",
            "telephone_number": "803-434-8323",
            "fax_number": "803-434-8326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Nicolls Rd",
            "address_2": "HSC room T12 Room 080",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "117948122",
            "country_code": "US",
            "telephone_number": "631-444-1116",
            "fax_number": "631-444-1535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHRISTIANSEN",
        "first_name": "COLLEEN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-01",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "004830",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.