NPIMap

Individual provider Active NPI

Michael C Tucker, MD

  • Orthopaedic Surgery Physician
  • Columbia, SC
National Provider Identifier
1205947249
Registry record updated Mar 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
039968 Issued in GA
Practice address
14 Richland Medical Park Dr Ste 200
Columbia, SC 29203-6882
Phone
(803) 296-7846
Fax
(803) 296-9699
NPI assigned
Aug 31, 2006
Last updated
Mar 9, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 039968 GA Primary

Addresses

Primary practice location

14 Richland Medical Park Dr Ste 200
Columbia, SC 29203-6882

Mailing address

PO Box 22265
Belfast, ME 04915-4473
Phone (803) 296-7320

Other practice location 1

1120 15th St
Augusta, GA 30912-0004
Phone (706) 721-2741

Other identifiers 2

IdentifierTypeStateIssuer
000655157AMedicaidGA
G39968MedicaidSC

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
I20080204000105 SC Practitioner - Orthopedic Surgery 7517049273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Medical University of South Carolina College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

14 Richland Medical Park Dr
Suite 200
Columbia, SC 29203-6882
Phone (803) 296-7846

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
039968GAMDOrthopaedic Surgery Physician
25446SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands Orthopaedic Surgery CurrentSince Dec 8, 2016 Accepting new patients
Prisma Health Medical Group-Midlands Orthopaedic Surgery Current Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Dec 8, 2016 Accepting new patients

Locations

14 Richland Medical Park Dr
Ste 200
Columbia, SC 29203
Phone (803) 296-9200

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

Interoperability endpoints

  • Direct secure messaging: mtucker385244@direct.ghs.myhfn.org

Organizations & group practices 3

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 7

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520553600000",
    "number": "1205947249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22265",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154473",
            "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": "14 RICHLAND MEDICAL PARK DR STE 200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036882",
            "telephone_number": "803-296-7846",
            "fax_number": "803-296-9699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 15th St",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309120004",
            "country_code": "US",
            "telephone_number": "706-721-2741",
            "fax_number": "706-721-4696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "039968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000655157A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G39968",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.