NPIMap

Individual provider Active NPI

Roham Moftakhar, M.D.

  • Neurological Surgery Physician
  • Columbia, SC
National Provider Identifier
1184689515
Registry record updated Mar 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
37893 Issued in SC
Practice address
3 Richland Medical Park Dr
Suite 310
Columbia, SC 29203-6849
Phone
(803) 434-8323
Fax
(803) 434-8326
NPI assigned
Apr 19, 2006
Last updated
Mar 22, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 036-129390 IL
Neurological Surgery Physician 207T00000X 37893 SC Primary
Neurological Surgery Physician 207T00000X 47499 WI

Addresses

Primary practice location

3 Richland Medical Park Dr
Suite 310
Columbia, SC 29203-6849

Mailing address

PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320

Other identifiers 1

IdentifierTypeStateIssuer
378932MedicaidSC

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
I20150620000027 SC Practitioner - Neurosurgery 5597958009 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
George Washington University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

3 Richland Medical Park Dr
Suite 310
Columbia, SC 29203-6862
Phone (803) 434-8323

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37893SCMDNeurological Surgery Physician
47499WIMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Nov 28, 2016 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Nov 28, 2016 Accepting new patients
University Neurosurgery Neurological Surgery Past Accepting new patients

Locations

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

3 Richland Medical Park Dr
Ste 310
Columbia, SC 29203
Phone (803) 434-8323

Interoperability endpoints

  • Direct secure messaging: rmoftakhar382429@direct.ghs.myhfn.org

Organizations & group practices 4

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521676800000",
    "number": "1184689515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904",
            "telephone_number": "803-296-7320",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RICHLAND MEDICAL PARK DR",
            "address_2": "SUITE 310",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036849",
            "telephone_number": "803-434-8323",
            "fax_number": "803-434-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFTAKHAR",
        "first_name": "ROHAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2018-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IL",
            "license": "036-129390",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "SC",
            "license": "37893",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WI",
            "license": "47499",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378932",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.