NPIMap

Organization Active NPI

Midlands Orthopaedics and Neurosurgery, PA

  • Orthopaedic Surgery Physician
  • Irmo, SC
National Provider Identifier
1124096979
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA
Practice address
1013 Lake Murray Blvd
Irmo, SC 29063-2824
Phone
(803) 256-4107
Fax
(803) 253-6676
NPI assigned
Mar 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

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

Authorized official

Name
Karen Kimberly Sooter
Title
Credentialing Coordinator
Phone
(803) 256-4107

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Durable Medical Equipment & Medical Supplies 332B00000X SC

Addresses

Primary practice location

1013 Lake Murray Blvd
Irmo, SC 29063-2824

Mailing address

1910 Blanding St
Columbia, SC 29201-3520
Phone (803) 256-4107

Other identifiers 2

IdentifierTypeStateIssuer
DME633OtherSCMEDICAID DME
PA3335MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930061725 SC DME Supplier - Multi-Specialty - Physician 8628963287 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Irmo, SC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1013 Lake Murray Blvd
#3
Irmo, SC 29063

Practitioners & affiliated clinicians

Practitioners 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1124096979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 BLANDING ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292013520",
            "telephone_number": "803-256-4107",
            "fax_number": "803-253-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 LAKE MURRAY BLVD",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632824",
            "telephone_number": "803-256-4107",
            "fax_number": "803-253-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-09",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "SOOTER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "KIMBERLY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "803-256-4107"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "DME633",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA3335",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irmo, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.