NPIMap

Organization Active NPI

Mental Illness Recovery Center

  • Community/Behavioral Health Agency
  • Columbia, SC
National Provider Identifier
1194047563
Registry record updated Sep 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MENTAL ILLNESS RECOVERY CENTER
Practice address
3809 Rosewood Dr
Columbia, SC 29205-3533
Phone
(803) 786-1844
Fax
(803) 939-2646
NPI assigned
Feb 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2020

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

Authorized official

Name
Ms. Julie Ann AvinNPI 1821126822
Title
President & Executive Director
Phone
(803) 786-1844

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
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

3809 Rosewood Dr
Columbia, SC 29205-3533

Mailing address

1408 Gregg St
Columbia, SC 29201
Phone (803) 786-1844

Other names 1

  • MIRCI Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101025000289 SC Part B Supplier - Clinic/Group Practice 1658564562 Receives reassigned benefits from 7 practitioners
Practice locations: Columbia, SC

National Provider Directory

National Provider Directory

Locations

3809 Rosewood Dr
Columbia, SC 29205
Phone (803) 939-2642

1433 Gregg St
Columbia, SC 29201
Phone (803) 312-1200

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/7878c7ba-d1a3-4bd2-9b45-7234d7142c12/

Practitioners 91

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

View all 91

NPI Registry JSON

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

{
    "created_epoch": "1267056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1194047563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 GREGG ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29201",
            "telephone_number": "803-786-1844",
            "fax_number": "803-939-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3809 ROSEWOOD DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292053533",
            "telephone_number": "803-786-1844",
            "fax_number": "803-939-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL ILLNESS RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-25",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "AVIN",
        "authorized_official_first_name": "JULIE ANN",
        "authorized_official_title_or_position": "PRESIDENT & EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "803-786-1844",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIRCI",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MIRCI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; 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.