Palmetto Retina Center LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

PALMETTO RETINA CENTER LLC

Practice address

124 Sunset Court
West Columbia, SC 29169

Phone

(803) 931-0077

Fax

(803) 931-0076

NPI assigned

Nov 2, 2005

Last updated

Dec 9, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John A Wells III, MDNPI 1841289154

Title

Managing Member

Phone

(803) 931-0077

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC, GA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 19

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.

• John A Wells III, MD

  • Ophthalmology Physician
  • West Columbia, SC
  • NPI 1841289154
  Medicare reassignment Care Compare group NPD Authorized official
• Barron Crawford Fishburne, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Columbia, SC
  • NPI 1316948243
  Medicare reassignment Care Compare group NPD
• Teresa Fowler, MD

  • Ophthalmology Physician
  • West Columbia, SC
  • NPI 1497301873
  Medicare reassignment Care Compare group NPD
• Jeffrey Glenn Gross, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Columbia, SC
  • NPI 1427059351
  Medicare reassignment Care Compare group NPD
• Stephen Matthew Hypes, D.O.

  • Retina Specialist (Ophthalmology) Physician
  • West Columbia, SC
  • NPI 1184064669

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• David L Johnson, MD

  • Retina Specialist (Ophthalmology) Physician
  • West Columbia, SC
  • NPI 1811942527
  Medicare reassignment Care Compare group NPD
• Nitin Nigam, MD

  • Retina Specialist (Ophthalmology) Physician
  • West Columbia, SC
  • NPI 1295058790
  Medicare reassignment Care Compare group NPD
• Manuel Alejandro Paez Escamilla, MD

  • Ophthalmology Physician
  • West Columbia, SC
  • NPI 1053873844
  Medicare reassignment Care Compare group NPD
• Shail P Patel

  • Ophthalmology Physician
  • West Columbia, SC
  • NPI 1336720499
  Medicare reassignment Care Compare group NPD
• John F Payne, MD

  • Ophthalmology Physician
  • West Columbia, SC
  • NPI 1528143021
  Medicare reassignment Care Compare group NPD
• Daniel V Will, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • West Columbia, SC
  • NPI 1861485906
  Medicare reassignment Care Compare group NPD
• Oksana Maria Demediuk, MD

  • Retina Specialist (Ophthalmology) Physician
  • Augusta, GA
  • NPI 1972599496

  SC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1255322806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SUNSET COURT",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "29169",
            "telephone_number": "803-931-0077",
            "fax_number": "803-931-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 SUNSET COURT",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "29169",
            "telephone_number": "803-931-0077",
            "fax_number": "803-931-0076"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "528 Broad St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Sumter",
            "state": "SC",
            "postal_code": "291503368",
            "country_code": "US",
            "telephone_number": "803-931-0077",
            "fax_number": "803-931-0076",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 N Cashua Dr",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "SC",
            "postal_code": "295012098",
            "country_code": "US",
            "telephone_number": "803-931-0077",
            "fax_number": "803-931-0076",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1170 Boulevard St Ste E",
            "address_purpose": "LOCATION",
            "city": "Orangeburg",
            "state": "SC",
            "postal_code": "291154359",
            "country_code": "US",
            "telephone_number": "803-931-0077",
            "fax_number": "803-931-0076",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1831 W Evans St Ste 315",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "SC",
            "postal_code": "295013300",
            "country_code": "US",
            "telephone_number": "803-931-0077",
            "fax_number": "803-931-0076",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2611 Forest Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292042372",
            "country_code": "US",
            "telephone_number": "803-931-0077",
            "fax_number": "803-931-0076",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1055 Silver Bluff Rd",
            "address_purpose": "LOCATION",
            "city": "Aiken",
            "state": "SC",
            "postal_code": "298035861",
            "country_code": "US",
            "telephone_number": "803-931-0077",
            "fax_number": "803-931-0076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALMETTO RETINA CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "803-931-0077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0623",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Palmetto Health - University of South Carolina Medical Group
• Palmetto Infusion Services LLC (Palmetto Infusion Services)
• Palmetto Medical Products
• Palmetto Pirate Provisions, LLC (Primal Gourmet)
• Palmetto Primary Care Physicians, LLC
• Palmetto Specialty Pharmacy
• Panacea Therapeutic Bodywork, LLC
• Margaret Crosby Papadea, M.D.
• Kelly Pappas
• Cayla Paradise, DMD

• Ophthalmology Physician in West Columbia, SC
• Providers in West Columbia, SC by specialty
• Ophthalmology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.