NPIMap

Organization Active NPI

Golden Corner Family Prac

  • Family Medicine Physician
  • West Union, SC
National Provider Identifier
1184771321
Registry record updated Mar 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GOLDEN CORNER FAMILY PRAC
Practice address
1205 N Highway 11
West Union, SC 29696-2715
Phone
(864) 638-5402
Fax
(864) 638-6126
NPI assigned
Jan 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

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

Authorized official

Name
Dr. Edward H. Booker Jr., M.D.
Title
Ceo
Phone
(864) 638-5402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X SC Primary

Addresses

Primary practice location

1205 N Highway 11
West Union, SC 29696-2715

Mailing address

PO Box 219
West Union, SC 29696-0219
Phone (864) 638-5402

Other identifiers 3

IdentifierTypeStateIssuer
094953MedicaidSC
L31366MedicaidSC
L31357MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090707000100 SC Part B Supplier - Clinic/Group Practice 5799836672 Receives reassigned benefits from 6 practitioners
Practice locations: West Union, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1184771321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219",
            "city": "WEST UNION",
            "state": "SC",
            "postal_code": "296960219",
            "telephone_number": "864-638-5402",
            "fax_number": "864-638-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 N HIGHWAY 11",
            "city": "WEST UNION",
            "state": "SC",
            "postal_code": "296962715",
            "telephone_number": "864-638-5402",
            "fax_number": "864-638-6126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN CORNER FAMILY PRAC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "BOOKER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "864-638-5402",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094953",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L31366",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L31357",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Union, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.