Dan Robert Bodison Jr., MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

19113 Issued in SC

Practice address

4605 Monticello Rd
Eau Claire Cooperative Health Center
Columbia, SC 29203-4156

Phone

(803) 252-7001

Fax

(803) 252-5219

NPI assigned

Jul 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dan.bodison.jr.1@10781.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 and National Provider Directory roles.

• Eau Claire Cooperative Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
  • NPI 1346249430

  Pediatrics

  Medicare reassignment NPD
• Eau Claire Cooperative Health Center ,Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
  • NPI 1588375653
  NPD
• Eau Claire Cooperative Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
  • NPI 1952727158
  NPD
• Pediatrics of Newberry, LLC

  • Pediatrics Physician
  • Newberry, SC
  • NPI 1659400851
  NPD (past)

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307059200000",
    "number": "1215937610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 MONTICELLO RD",
            "address_2": "EAU CLAIRE COOPERATIVE HEALTH CENTER",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292034156",
            "telephone_number": "803-252-7001",
            "fax_number": "803-252-5219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 MONTICELLO RD",
            "address_2": "EAU CLAIRE COOPERATIVE HEALTH CENTER",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292034156",
            "telephone_number": "803-252-7001",
            "fax_number": "803-252-5219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODISON",
        "first_name": "DAN",
        "middle_name": "ROBERT",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2011-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "19113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119134",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rodel V Bobadilla, N.P.
• Bonni L. Bobb, RN
• Trina Lanice Bobo-Simmons
• Abigail Brooke Bocchino
• Bodies by Craft LLC
• Alexandra Jean Bodnariuk, LMSW
• Body & Mind Wellness
• Emily Boening, LPC, NCC
• Elizabeth Boessneck, APRN
• Eva Frank Bogaerts

• Pediatrics Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.