NPIMap

Organization Active NPI

Pain Specialists of Charleston

Doing business as Pain Specialists of Columbia

  • Specialist
  • Columbia, SC
National Provider Identifier
1235583576
Registry record updated Aug 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
16626 Issued in SC
Legal business name
PAIN SPECIALISTS OF CHARLESTON
Doing business as
Pain Specialists of Columbia
Practice address
15 Monckton Blvd
Columbia, SC 29206-4700
Phone
(803) 252-4900
NPI assigned
Apr 22, 2016
Last updated
Aug 11, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PAIN SPECIALISTS OF CHARLESTONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 11, 2021

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

Authorized official

Name
Dr. Edward Marion Tavel, MDNPI 1508833468
Title
President
Phone
(843) 818-1181

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 16626 SC Primary

Addresses

Primary practice location

15 Monckton Blvd
Columbia, SC 29206-4700

Mailing address

2695 Elms Plantation Blvd
Suite a
North Charleston, SC 29406-7132
Phone (843) 818-1181

Other identifiers 1

IdentifierTypeStateIssuer
166262MedicaidSC

Other names 1

  • Pain Specialists of Columbia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160527000055 SC DME Supplier - Physician - General Practice 6002971165 Practice locations: Columbia, SC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Pain Specialists Charleston

Locations

4875 Forest Dr
Columbia, SC 29206

2695 Elms Plantation Blvd
North Charleston, SC 29406
Phone (843) 818-1181

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1461283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628640000000",
    "number": "1235583576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ELMS PLANTATION BLVD",
            "address_2": "SUITE A",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294067132",
            "telephone_number": "843-818-1181",
            "fax_number": "843-818-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MONCKTON BLVD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292064700",
            "telephone_number": "803-252-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN SPECIALISTS OF CHARLESTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAIN SPECIALISTS OF CHARLESTON",
        "enumeration_date": "2016-04-22",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A",
        "authorized_official_last_name": "TAVEL",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "MARION",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-818-1181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "16626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166262",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pain Specialists of Columbia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.