Ayesha Monay McCormick, AGNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APN.29792 Issued in SC

Practice address

2611 Forest Dr Ste 200
Columbia, SC 29204-2371

Phone

(803) 779-3263

Fax

(803) 779-3207

NPI assigned

Oct 27, 2022

Last updated

Jan 3, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Alabama School of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Palmetto Pain Management LLCGroup PAC ID 9234307521, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ayesha.mccormick.1@17099.direct.athenahealth.com

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.

• Palmetto Pain Management LLC

  • Interventional Pain Medicine Physician
  • Columbia, SC
  • NPI 1861411738
  Medicare reassignment Care Compare group NPD
• Palmetto Pain Management, LLC

  • Non-Pharmacy Dispensing Site
  • Columbia, SC
  • NPI 1629457650
  NPD (past)

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1215644489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 FOREST DR STE 200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042371",
            "telephone_number": "037-793-2638",
            "fax_number": "803-779-3207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 FOREST DR STE 200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042371",
            "telephone_number": "803-779-3263",
            "fax_number": "803-779-3207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "AYESHA",
        "middle_name": "MONAY",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-27",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "SC",
            "license": "APN.29792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BOARD OF NURSING",
            "identifier": "319785",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA BOARD OF NURSING",
            "identifier": "95074286",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Tina McComb, REGISTERED NURSE
• Douglas Mitchell McConnell, MD
• Monica Joanne McConnell, PH.D.
• Kelly Heath McCook, P.T.
• Monica McCorkle
• Brant Ashton McCormick, RT(R)(CT), ARRT
• Cierra McCormick
• Priscilla B. McCormick, RN
• Jenna McCoury, RBT
• Chloe McCoy, M.D.

• Gerontology Nurse Practitioner in Columbia, SC
• Providers in Columbia, SC by specialty
• Gerontology Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.