NPIMap

Organization Active NPI

Dillon Internal Medicine Associates PA

  • Internal Medicine Physician
  • Dillon, SC
National Provider Identifier
1124115886
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DILLON INTERNAL MEDICINE ASSOCIATES PA
Practice address
705 N 8TH Ave
Suite 1a
Dillon, SC 29536-2549
Phone
(843) 774-2478
Fax
(843) 774-0293
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Authorized official

Name
James P Wallace, MDNPI 1487741146
Title
President
Phone
(843) 774-2478

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X SC Primary

Addresses

Primary practice location

705 N 8TH Ave
Suite 1a
Dillon, SC 29536-2549

Mailing address

705 N 8TH Ave Ste 1a
Dillon, SC 29536-2549
Phone (843) 774-2478

Other identifiers 2

IdentifierTypeStateIssuer
7901443MedicaidNC
PA8526MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040607000923 SC Part B Supplier - Clinic/Group Practice 5991617995 Receives reassigned benefits from 10 practitioners
Practice locations: Dillon, SC

National Provider Directory

National Provider Directory

Locations

3263 Highway 301 S
Latta, SC 29565
Phone (843) 752-2091

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/0900120

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1124115886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 N 8TH AVE STE 1A",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295362549",
            "telephone_number": "843-774-2478",
            "fax_number": "843-774-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 N 8TH AVE",
            "address_2": "SUITE 1A",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295362549",
            "telephone_number": "843-774-2478",
            "fax_number": "843-774-0293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DILLON INTERNAL MEDICINE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-774-2478",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7901443",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA8526",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dillon, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.