NPIMap

Individual provider Active NPI

Siraj F. Abdullah, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Columbia, SC
National Provider Identifier
1235450685
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
1396 Issued in SC
Practice address
3209 Colonial Drive
Family Medicine Center
Columbia, SC 29203-6809
Phone
(803) 434-6116
Fax
(803) 434-8478
NPI assigned
Jun 21, 2010
Last updated
Feb 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1396 SC
Sports Medicine (Family Medicine) Physician 207QS0010X 1396 SC Primary

Addresses

Primary practice location

3209 Colonial Drive
Family Medicine Center
Columbia, SC 29203-6809

Mailing address

3209 Colonial Drive
Family Medicine Center
Columbia, SC 29203-6894
Phone (803) 434-6113

Other identifiers 1

IdentifierTypeStateIssuer
013960MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, GA, AL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140903001240 SC Practitioner - Sports MedicinePractitioner - Family Practice 1759509854 Reassigns benefits to 1 organization
I20181105001960 GA Practitioner - Sports MedicinePractitioner - Family Practice 1759509854 Reassigns benefits to 2 organizations
I20200313000561 AL Practitioner - Family PracticePractitioner - Sports Medicine 1759509854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Columbus Ambulatory Healthcare Services, Inc.Group PAC ID 1355244385, shared by 2 NPIs, 157 clinicians

Practice addresses (Care Compare)

1800 10TH Ave
Columbus, GA 31901-1529
Phone (706) 571-1120

1810 Stadium Dr
Suite 240
Phenix City, AL 36867-3179
Phone (334) 291-8303

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1396SCMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health-Midlands Current Accepting new patients
Prisma Health-Midlands CurrentSince Jan 7, 2015 Accepting new patients
Palmetto Health Family Medicine CurrentSince Jan 7, 2015 Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. Family Medicine CurrentSince Nov 1, 2018 Accepting new patients
Chattahoochee Valley Family Family Medicine CurrentSince Mar 23, 2020 Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. Family Medicine CurrentSince Nov 1, 2018 Accepting new patients
Prisma Health Medical Group-Midlands Past Accepting new patients
Palmetto Health Past Accepting new patients

Locations

1810 Stadium Dr
Ste 240
Phenix City, AL 36867
Phone (334) 291-8303

1800 10th Ave
Columbus, GA 31901
Phone (706) 571-1120

707 Center St
Ste 110
Columbus, GA 31901
Phone (706) 494-4300

100 Palmetto Health Pkwy
Ste 104
Columbia, SC 29212
Phone (803) 434-5668

Organizations & group practices 9

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": "1277078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424736000000",
    "number": "1235450685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 COLONIAL DRIVE",
            "address_2": "FAMILY MEDICINE CENTER",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036894",
            "telephone_number": "803-434-6113",
            "fax_number": "803-434-7231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3209 COLONIAL DRIVE",
            "address_2": "FAMILY MEDICINE CENTER",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036809",
            "telephone_number": "803-434-6116",
            "fax_number": "803-434-8478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDULLAH",
        "first_name": "SIRAJ",
        "middle_name": "F.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-21",
        "last_updated": "2015-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "1396",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "SC",
            "license": "1396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013960",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.