Active NPI
Travis Wayne Mize, D.M.D., M.H.S.
- Periodontics
- West Columbia, SC
National Provider Identifier
1265682686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 826
- Practice address
- 159 Medical Cir
West Columbia, SC 29169-3655 - Phone
- (803) 794-7520
- NPI assigned
- Sep 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4466 | SC | |
| Periodontics | 1223P0300X | DN1855503 | MA | |
| Periodontics | 1223P0300X | 826 | SC | Primary |
Addresses
Primary practice location
159 Medical Cir
West Columbia, SC 29169-3655
Mailing address
159 Medical Cir
West Columbia, SC 29169-3655
Phone (803) 794-7520
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 2, 2016 through Feb 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1855503 | MA | MD | Periodontist |
| 4466 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunset Periodontics, LLC | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Periodontics
- West Columbia, SC
- NPI 1598142341
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433376000000",
"number": "1265682686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 MEDICAL CIR",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291693655",
"telephone_number": "803-794-7520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 MEDICAL CIR",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291693655",
"telephone_number": "803-794-7520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIZE",
"first_name": "TRAVIS",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "D.M.D., M.H.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-22",
"last_updated": "2015-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "4466",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "DN1855503",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "SC",
"license": "826",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.