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Individual provider Active NPI

Olivia Nicole Moore

  • Physician Assistant
  • Columbia, SC
National Provider Identifier
1104513589
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4894 Issued in SC
Practice address
1333 Taylor St Ste 6F
Columbia, SC 29201-2953
Phone
(803) 296-3273
Fax
(803) 296-7061
NPI assigned
Apr 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 4894 SC Primary

Addresses

Primary practice location

1333 Taylor St Ste 6F
Columbia, SC 29201-2953

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-5603

Other names 1

  • Olivia Nicole Moore Professional name

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
I20230712000475 SC Practitioner - Physician Assistant 4183084973 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Carolina School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

11 Richland Medical Park Dr
Columbia, SC 29203-6863
Phone (803) 434-4506

1330 Taylor St
Columbia, SC 29201-2915
Phone (803) 434-6771

2 Medical Park Rd
Suite 506
Columbia, SC 29203-6876
Phone (803) 540-1000

400 Palmetto Health Pkwy
Columbia, SC 29212-1760
Phone (803) 296-5579

7 Richland Medical Park Dr
Columbia, SC 29203-6863

Hospital & facility affiliations

  • Prisma Health Baptist Parkridge Hospital, Columbia, SC, CCN 420106
  • Prisma Health Richland Hospital Hospital, Columbia, SC, CCN 420018
  • Prisma Health Baptist Hospital, Columbia, SC, CCN 420086

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4894SCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Jul 24, 2023 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jul 24, 2023 Accepting new patients
Prisma Health Medical Group-Midlands Past Accepting new patients

Locations

1333 Taylor St
Ste 6F
Columbia, SC 29201
Phone (803) 296-3273

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

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.

Hospital & facility affiliations 10

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": "1681776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1104513589",
    "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": "864-522-5603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 TAYLOR ST STE 6F",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012953",
            "telephone_number": "803-296-3273",
            "fax_number": "803-296-7061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "OLIVIA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLIVIA",
            "last_name": "MOORE",
            "middle_name": "NICOLE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.