NPIMap

Organization Active NPI

Palmetto Ophthalmology Associates, P.a.

  • Ophthalmology Physician
  • Lexington, SC
National Provider Identifier
1275580805
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PALMETTO OPHTHALMOLOGY ASSOCIATES, P.A.
Practice address
340 W Butler St
Lexington, SC 29072-2606
Phone
(803) 359-8777
Fax
(803) 359-1513
NPI assigned
May 28, 2006
Last updated
Oct 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Mark Sanford Keisler, MDNPI 1023159431
Title
Owner/President
Phone
(803) 359-8777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

340 W Butler St
Lexington, SC 29072-2606

Mailing address

340 W Butler St
Lexington, SC 29072-2606
Phone (803) 359-8777

Other identifiers 5

IdentifierTypeStateIssuer
138381MedicaidSC
Q91004MedicaidSC
GP2314MedicaidSC
113326MedicaidSC
PC3867MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031201000245 SC Part B Supplier - Clinic/Group Practice 8628973922 Receives reassigned benefits from 8 practitioners
Practice locations: Irmo, SC; Lexington, SC; Leesville, SC
O20100930076965 SC DME Supplier - Physician - Ophthalmology 8628973922 Practice locations: Lexington, SC

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Palmetto Ophthalmology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1275580805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 W BUTLER ST",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290722606",
            "telephone_number": "803-359-8777",
            "fax_number": "803-359-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 W BUTLER ST",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290722606",
            "telephone_number": "803-359-8777",
            "fax_number": "803-359-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO OPHTHALMOLOGY ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "KEISLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "SANFORD",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "803-359-8777",
        "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": "138381",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q91004",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2314",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113326",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PC3867",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.