NPIMap

Individual provider Active NPI

Cody Robertson

  • Family Medicine Physician
  • Newberry, SC
National Provider Identifier
1225560675
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
84922 Issued in SC
Practice address
2605 Kinard St
Newberry, SC 29108-2967
Phone
(803) 405-1900
Fax
(803) 405-1919
NPI assigned
Apr 3, 2017
Last updated
Mar 28, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 84922 SC Primary

Addresses

Primary practice location

2605 Kinard St
Newberry, SC 29108-2967

Mailing address

2605 Kinard St
Newberry, SC 29108-2967
Phone (803) 405-1900

Other practice location 1

1409 W Georgia Rd Ste B
Simpsonville, SC 29680-6420
Phone (864) 454-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address crobertson273416@direct.ghs.myhfn.org

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
I20200923003283 SC Practitioner - Family Practice 7517239676 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Regional HealthcareGroup PAC ID 4082527742, 159 clinicians
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Practice addresses (Care Compare)

2605 Kinard St
Suite 200a
Newberry, SC 29108-2965
Phone (803) 405-1900

298 Commerce Dr
Newberry, SC 29108-2953
Phone (803) 321-3232

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
84922SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Self Regional Healthcare CurrentSince Oct 2, 2025 Accepting new patients
Self Regional Healthcare Family Medicine Current Accepting new patients
Self Medical Group CurrentSince Sep 1, 2022 Accepting new patients
Self Regional Healthcare Family Medicine CurrentSince Oct 2, 2025 Accepting new patients
Self Medical Group CurrentSince Sep 1, 2022 Accepting new patients
Self Medical Group Current Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

75 Remittance Dr
Dept 6793
Chicago, IL 60675

155 Academy Ave
Greenwood, SC 29646
Phone (864) 725-4865

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

2605 Kinard St
Ste 200A
Newberry, SC 29108
Phone (803) 405-1900

Interoperability endpoints

  • Direct secure messaging: crobertson273416@selfregional.direct-ci.net

Organizations & group practices 7

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 6

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": "1491177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1225560675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 KINARD ST",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "291082967",
            "telephone_number": "803-405-1900",
            "fax_number": "803-405-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 KINARD ST",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "291082967",
            "telephone_number": "803-405-1900",
            "fax_number": "803-405-1919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1409 W Georgia Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Simpsonville",
            "state": "SC",
            "postal_code": "296806420",
            "country_code": "US",
            "telephone_number": "864-454-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "CODY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-03",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "84922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "crobertson273416@direct.ghs.myhfn.org",
            "affiliation": "N",
            "address_1": "1409 W Georgia Rd Ste B",
            "city": "Simpsonville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296806420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newberry, SC

Sources for this page

Verify at the official NPI Registry.