Columbia Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

14628 Issued in SC

Legal business name

COLUMBIA MEDICAL GROUP

Practice address

4540 Trenholm Rd
Columbia, SC 29206-4462

Phone

(803) 790-4700

Fax

(803) 790-6130

NPI assigned

Nov 21, 2005

Last updated

Oct 16, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David William Gavin

Title

Office Manager

Phone

(803) 790-4700

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erik Steven Crook, M.D.

  • Internal Medicine Physician
  • Columbia, SC
  • NPI 1659449544
  NPD (past)
• Edgar G Deschamps III, MD

  • Internal Medicine Physician
  • Columbia, SC
  • NPI 1699734483
  NPD (past)
• Edward W Haselden Jr., MD

  • Internal Medicine Physician
  • Columbia, SC
  • NPI 1306805197
  NPD (past)
• Rosa M Jimenez, MD

  • Internal Medicine Physician
  • Columbia, SC
  • NPI 1912966714
  NPD (past)
• Ruben L Mayer, MD

  • Internal Medicine Physician
  • Columbia, SC
  • NPI 1891755039
  NPD (past)
• Lora Kim Meadows, MD

  • Internal Medicine Physician
  • Hilton Head, SC
  • NPI 1255391496
  NPD (past)
• Stacie K Moore-Bowens, MD

  • Internal Medicine Physician
  • Columbia, SC
  • NPI 1225098478
  NPD (past)
• Gueorgui Iankov Mouratev, M.D.

  • Specialist
  • Columbia, SC
  • NPI 1902814122
  NPD (past)
• Bradley W Word, MD

  • Internal Medicine Physician
  • Columbia, SC
  • NPI 1043279854
  NPD (past)

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1174506497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 TRENHOLM RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292064462",
            "telephone_number": "803-790-4700",
            "fax_number": "803-790-6130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 TRENHOLM RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292064462",
            "telephone_number": "803-790-4700",
            "fax_number": "803-790-6130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-21",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-790-4700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "14628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2807",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Columbia Hearing Center LLC
• Columbia Heart Clinic, PA (Columbia Heart Clinic)
• Columbia Institute for Individual, Marriage and Family Therapy
• Columbia International University
• Columbia Medical Associates, P.a.
• Columbia Medical Supplies, LLC
• Columbia Nephrology Associates PA
• Columbia Nephrology Associates PA
• Columbia Neurological Associates, PA
• Columbia Northeast Counseling Services, LLC

• Internal Medicine Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.