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Individual provider Active NPI

Lisa Fanning Etheridge, FNP/APRN

  • Family Nurse Practitioner
  • Orangeburg, SC
National Provider Identifier
1245784669
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
20081 Issued in SC
Practice address
1175 Cook Rd Ste 320
Orangeburg, SC 29118-8247
Phone
(803) 395-3960
NPI assigned
Aug 15, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 20081 SC Primary

Addresses

Primary practice location

1175 Cook Rd Ste 320
Orangeburg, SC 29118-8247

Mailing address

914 Reynolds Rd
Barnwell, SC 29812
Phone (803) 259-5311

Other practice location 1

914 Reynolds Rd
Barnwell, SC 29812-6358
Phone (803) 259-5311

Other identifiers 1

IdentifierTypeStateIssuer
7389OtherMEDICARE GROUP PTAN

Other names 1

  • Lisa Fanning Smith Former name

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
I20171010000678 SC Practitioner - Nurse Practitioner 1759656242 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

106 Causeway CT
Bowman, SC 29018-8404
Phone (803) 395-3025

506 N St
Bamberg, SC 29003-1319
Phone (803) 245-6290

Hospital & facility affiliations

  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Mar 1, 2023 Accepting new patients
The Regional Medical Center of Orangeburg and Calhoun Counties CurrentSince Dec 12, 2022 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties CurrentSince Dec 12, 2022 Accepting new patients
Musc Community Physicians CurrentSince Mar 1, 2023 Accepting new patients
The Regional Medical Center of Orangeburg and Calhoun Counties Current Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients

Locations

3488 Main Hwy
Bamberg, SC 29003

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

106 Causeway Ct
Bowman, SC 29018
Phone (803) 395-3025

215 Dorange Rd
Branchville, SC 29432
Phone (803) 274-8400

187 Bunch Ford Rd
Holly Hill, SC 29059
Phone (803) 395-3068

1097B Cook Rd
Orangeburg, SC 29118
Phone (803) 534-5110

1175 Cook Rd
Ste 320
Orangeburg, SC 29118
Phone (803) 395-3960

Organizations & group practices 6

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.

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": "1471219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1245784669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 REYNOLDS RD",
            "city": "BARNWELL",
            "state": "SC",
            "postal_code": "29812",
            "telephone_number": "803-259-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 COOK RD STE 320",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291188247",
            "telephone_number": "803-395-3960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "914 Reynolds Rd",
            "address_purpose": "LOCATION",
            "city": "Barnwell",
            "state": "SC",
            "postal_code": "298126358",
            "country_code": "US",
            "telephone_number": "803-259-5311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "LISA",
        "middle_name": "FANNING",
        "credential": "FNP/APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "20081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "7389",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "SMITH",
            "middle_name": "FANNING",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orangeburg, SC

Sources for this page

Verify at the official NPI Registry.