Individual provider Active NPI

Alyssa Marian Davolio

  • Pediatrics Physician
  • Columbia, SC
National Provider Identifier
1124692678
Registry record updated Aug 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
LL83563 Issued in SC
Practice address
Prisma Health Children'S Hospital Outpatient Center
14 Medical Park, Ste 400
Columbia, SC 29203
Phone
(803) 434-6155
Fax
(803) 434-6979
NPI assigned
May 19, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X LL83563 SC Primary

Addresses

Primary practice location

Prisma Health Children'S Hospital Outpatient Center
14 Medical Park, Ste 400
Columbia, SC 29203

Mailing address

Prisma Health Children'S Hospital Outpatient Center
14 Medical Park, Ste 400
Columbia, SC 29203
Phone (803) 434-6155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210809003344 SC Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 4981008281

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LL83563SCMDPediatrics Physician

NPI Registry JSON

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1124692678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER",
            "address_2": "14 MEDICAL PARK, STE 400",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-6155",
            "fax_number": "803-434-6979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER",
            "address_2": "14 MEDICAL PARK, STE 400",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-6155",
            "fax_number": "803-434-6979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVOLIO",
        "first_name": "ALYSSA",
        "middle_name": "MARIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL83563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.