NPIMap

Individual provider Active NPI

Fred J Kudrik, MD

  • Hematology & Oncology Physician
  • Columbia, SC
National Provider Identifier
1104807668
Registry record updated Nov 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
22933 Issued in SC
Practice address
166 Stoneridge Dr
Columbia, SC 29210-8239
Phone
(803) 461-3000
Fax
(803) 461-4910
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 22933 SC Primary

Addresses

Primary practice location

166 Stoneridge Dr
Columbia, SC 29210-8239

Mailing address

PO Box 2046
West Columbia, SC 29171-2046
Phone (803) 461-3000

Other identifiers 2

IdentifierTypeStateIssuer
229336MedicaidSC
6275OtherSCMCARE GROUP#

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
I20050201000629 SC Practitioner - Hematology/OncologyPractitioner - Medical Oncology 6002867637 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Carolina Oncology Assoc PAGroup PAC ID 6103739024, 18 clinicians

Practice addresses (Care Compare)

166 Stoneridge Dr
Columbia, SC 29210-8239
Phone (803) 461-3000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Carolina Oncology Assoc PA Hematology & Oncology CurrentSince Jun 1, 2002 Accepting new patients

Locations

166 Stoneridge Dr
Columbia, SC 29210
Phone (803) 296-5954

7 Richland Medical Park Dr
Columbia, SC 29203
Phone (803) 434-3040

120 W Hospital Dr
West Columbia, SC 29169
Phone (803) 739-6500

Interoperability endpoints

  • Direct secure messaging: fkudrik380656@direct.musc.edu

Organizations & group practices 1

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": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257984000000",
    "number": "1104807668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2046",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291712046",
            "telephone_number": "803-461-3000",
            "fax_number": "803-461-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 STONERIDGE DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292108239",
            "telephone_number": "803-461-3000",
            "fax_number": "803-461-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDRIK",
        "first_name": "FRED",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2009-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "22933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "229336",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE GROUP#",
            "identifier": "6275",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.