Organization Active NPI

Lancaster One Medical PA

  • Primary Care Clinic/Center
  • Lancaster, SC
National Provider Identifier
1174620520
Registry record updated Nov 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
8904 Issued in SC
Legal business name
LANCASTER ONE MEDICAL PA
Practice address
539 Hwy 9 Bypass E
Lancaster, SC 29720
Phone
(803) 286-5700
Fax
(803) 285-6119
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2010

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

Authorized official

Name
Mrs. Xiaolu J Dong, DCNPI 1265500144
Title
Owner Physician
Phone
(803) 286-5700

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
Primary Care Clinic/Center 261QP2300X 8904 SC Primary

Addresses

Primary practice location

539 Hwy 9 Bypass E
Lancaster, SC 29720

Mailing address

539 Hwy 9 Bypass E
Lancaster, SC 29720
Phone (803) 286-5700

Other identifiers 3

IdentifierTypeStateIssuer
089040MedicaidSC
CH2095MedicaidSC
CH1486MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110228000652 SC Part B Supplier - Clinic/Group Practice 4981885696 Receives reassigned benefits from 6 practitioners
Practice locations: Lancaster, SC

National Provider Directory

National Provider Directory

Locations

539 Highway 9 Byp E
Lancaster, SC 29720
Phone (803) 286-5700

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289779200000",
    "number": "1174620520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 HWY 9 BYPASS E",
            "city": "LANCASTER",
            "state": "SC",
            "postal_code": "29720",
            "telephone_number": "803-286-5700",
            "fax_number": "803-285-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 HWY 9 BYPASS E",
            "city": "LANCASTER",
            "state": "SC",
            "postal_code": "29720",
            "telephone_number": "803-286-5700",
            "fax_number": "803-285-6119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANCASTER ONE MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2010-11-15",
        "status": "A",
        "authorized_official_last_name": "DONG",
        "authorized_official_first_name": "XIAOLU",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "803-286-5700",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "SC",
            "license": "8904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "089040",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH2095",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH1486",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2010; 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.