NPIMap

Individual provider Active NPI

David Glenn Whaley Jr., M.D.

  • Family Medicine Physician
  • Sumter, SC
National Provider Identifier
1174630297
Registry record updated Mar 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19754 Issued in SC
Practice address
325 Broad St
Suite 100
Sumter, SC 29150-4152
Phone
(803) 773-5227
Fax
(803) 418-0202
NPI assigned
Aug 24, 2006
Last updated
Mar 10, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19754 SC Primary

Addresses

Primary practice location

325 Broad St
Suite 100
Sumter, SC 29150-4152

Mailing address

325 Broad St
Suite 100
Sumter, SC 29150-4167
Phone (803) 773-5227

Other identifiers 2

IdentifierTypeStateIssuer
197548MedicaidSC
080193764OtherSCMEDICARE RR PIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100929001069 SC Practitioner - Family Practice 1759299936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
North Carolina Medical School, 1996
Medicare assignment
May accept Medicare assignment
Group practices
Colonial Family Practice LLCGroup PAC ID 9931017118, 58 clinicians

Practice addresses (Care Compare)

674 W Liberty St
Sumter, SC 29150-4882
Phone (803) 773-5227

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19754SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Colonial Family Practice, LLC Family Medicine CurrentSince Nov 1, 2001 Accepting new patients
Colonial Family Practice, LLC Family Medicine Current Accepting new patients
Colonial Family Practice, LLC Family Medicine Past Accepting new patients
Colonial Family Practice, LLC Family Medicine Past Accepting new patients
Colonial Family Practice, LLC Family Medicine Past Accepting new patients
Colonial Family Practice, LLC Family Medicine Past Accepting new patients
Colonial Family Practice, LLC Family Medicine Past Accepting new patients
Colonial Family Practice - Manning Family Medicine Past Accepting new patients
Colonial Family Practice, LLC Family Medicine Past Accepting new patients
Colonial Family Practice, LLC Family Medicine Past Accepting new patients
Colonial Family Practice, LLC Past Accepting new patients
Colonial Family Practice & Ambulatory Care Center Family Medicine Past Accepting new patients
Colonial Family Practice, LLC Family Medicine Past Accepting new patients

Locations

1124 Little St
Camden, SC 29020
Phone (803) 432-9899

4700 Forest Dr
Columbia, SC 29206
Phone (803) 256-1511

1013 Professional Ct
Ste A
Manning, SC 29102
Phone (803) 433-7425

1013 Professional Ct
Ste C
Manning, SC 29102
Phone (803) 433-7425

1036 Professional Ct
Manning, SC 29102
Phone (803) 433-5220

308 W Wesmark Blvd
Sumter, SC 29150
Phone (803) 905-1200

325 Broad St
Sumter, SC 29150

325 Broad St
Ste 100
Sumter, SC 29150

325 Broad St
Ste 200
Sumter, SC 29150
Phone (803) 775-4469

327 Broad St
Sumter, SC 29150
Phone (803) 774-2781

385 W Wesmark Blvd
Sumter, SC 29150
Phone 8037735227 ext. 1013

674 W Liberty St
Sumter, SC 29150
Phone 80377352276010

742 W Liberty St
Sumter, SC 29150
Phone (803) 773-3391

Interoperability endpoints

  • Direct secure messaging: david.whaley@colonialhealthcare.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/CIHIBD

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268179200000",
    "number": "1174630297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 BROAD ST",
            "address_2": "SUITE 100",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504167",
            "telephone_number": "803-773-5227",
            "fax_number": "803-418-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 BROAD ST",
            "address_2": "SUITE 100",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504152",
            "telephone_number": "803-773-5227",
            "fax_number": "803-418-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHALEY",
        "first_name": "DAVID",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2010-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "19754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197548",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR PIN",
            "identifier": "080193764",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumter, SC

Sources for this page

Verify at the official NPI Registry.