NPIMap

Organization Active NPI

Inmed Diagnostics Services of SC LLC

  • Radiology Clinic/Center
  • Columbia, SC
National Provider Identifier
1104889377
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
19347 Issued in SC
Legal business name
INMED DIAGNOSTICS SERVICES OF SC LLC
Practice address
126 S Assembly St
Columbia, SC 29201-4545
Phone
(803) 988-0082
Fax
(803) 988-0095
NPI assigned
Apr 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Authorized official

Name
Carmen Restivo
Title
Compliance & Credentialing Manager
Phone
(352) 241-6100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 19347 SC Primary
Radiology Clinic/Center 261QR0200X

Addresses

Primary practice location

126 S Assembly St
Columbia, SC 29201-4545

Mailing address

PO Box 593869
Orlando, FL 32859-3869
Phone (352) 241-6100

Other practice location 1

1728 Village Park Dr
Orangeburg, SC 29118-2426
Phone (803) 536-1106

Other identifiers 1

IdentifierTypeStateIssuer
PL0036MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20141024001989 SC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7315901972 Receives reassigned benefits from 3 practitioners
Practice locations: Columbia, SC
O20200515000304 SC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7315901972 Receives reassigned benefits from 1 practitioner
Practice locations: Orangeburg, SC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1081083Inmed Diagnostics of SC LLC1728 Village Park Drive, Orangeburg, SC 29118Certificate of waiverMar 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
Inmed Diagnostic Services of SC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1704 E Main St
Duncan, SC 29334
Phone (864) 486-8595

1120 W Evans St
Florence, SC 29501
Phone (843) 292-0082

1803 W Palmetto St
Ste A
Florence, SC 29501
Phone (843) 292-0082

4701 Oleander Dr
Myrtle Beach, SC 29577
Phone (843) 692-0040

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738886400000",
    "number": "1104889377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 593869",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328593869",
            "telephone_number": "352-241-6100",
            "fax_number": "352-241-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S ASSEMBLY ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292014545",
            "telephone_number": "803-988-0082",
            "fax_number": "803-988-0095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1728 Village Park Dr",
            "address_purpose": "LOCATION",
            "city": "Orangeburg",
            "state": "SC",
            "postal_code": "291182426",
            "country_code": "US",
            "telephone_number": "803-536-1106",
            "fax_number": "803-535-6033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INMED DIAGNOSTICS SERVICES OF SC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A",
        "authorized_official_last_name": "RESTIVO",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "COMPLIANCE & CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "352-241-6100"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "SC",
            "license": "19347",
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PL0036",
            "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 Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.