Carolina Geriatric Specialists, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

22541 Issued in SC

Legal business name

CAROLINA GERIATRIC SPECIALISTS, LLC

Practice address

244 Church St
Sumter, SC 29150-4256

Phone

(803) 775-1001

Fax

(803) 774-1012

NPI assigned

Jun 17, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Macdonald Mayes Dubose, MDNPI 1265418164

Title

Owner

Phone

(803) 775-1001

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 10

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

• Macdonald Mayes Dubose, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Sumter, SC
  • NPI 1265418164
  Medicare reassignment Care Compare group NPD Authorized official
• Kristy Bass, ARNP

  • Family Nurse Practitioner
  • Sumter, SC
  • NPI 1184905283
  Medicare reassignment Care Compare group NPD
• George Scot Dilts, M.D.

  • Emergency Medicine Physician
  • Sumter, SC
  • NPI 1699861377
  Medicare reassignment Care Compare group NPD
• Laurin Gaymon Lee, FNP-BC

  • Family Nurse Practitioner
  • Sumter, SC
  • NPI 1063897726
  Medicare reassignment Care Compare group NPD
• David T Shook, MD

  • Family Medicine Physician
  • Anderson, SC
  • NPI 1811284649
  Medicare reassignment Care Compare group NPD
• Philip H Brandt, MD

  • Internal Medicine Physician
  • Sumter, SC
  • NPI 1487642443
  NPD (past)
• John Edgar Kleckley, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Columbia, SC
  • NPI 1356544100
  NPD (past)
• Andrew J. Reynolds, MD

  • Internal Medicine Physician
  • Sumter, SC
  • NPI 1144218009
  NPD (past)
• Hugh T Stoddard Jr., MD

  • Internal Medicine Physician
  • Sumter, SC
  • NPI 1497743595
  NPD (past)
• Daniel B Berry, MD

  • Internal Medicine Physician
  • Clyde, OH
  • NPI 1669431938
  NPD (past)

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

{
    "created_epoch": "1308268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1124313101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 CHURCH ST",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504256",
            "telephone_number": "803-775-1001",
            "fax_number": "803-774-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 CHURCH ST",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504256",
            "telephone_number": "803-775-1001",
            "fax_number": "803-774-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA GERIATRIC SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-17",
        "last_updated": "2015-07-16",
        "status": "A",
        "authorized_official_last_name": "DUBOSE",
        "authorized_official_first_name": "MACDONALD",
        "authorized_official_middle_name": "MAYES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-775-1001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": "22541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265418164",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Sumter, SC
• Providers in Sumter, SC by specialty
• Specialist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; 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.