NPIMap

Organization Active NPI

Providence Orthopaedic Group

  • Orthopaedic Surgery Physician
  • Lexington, SC
National Provider Identifier
1285674572
Registry record updated Jun 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
570521956 Issued in SC
Legal business name
PROVIDENCE ORTHOPAEDIC GROUP
Practice address
4721 Sunset Blvd
Suite a
Lexington, SC 29072-9151
Phone
(803) 227-8007
Fax
(803) 996-3180
NPI assigned
Jun 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2010

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

Authorized official

Name
Mr. Sean McNally
Title
Ceo
Phone
(803) 227-8152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X 570521956 SC Primary

Addresses

Primary practice location

4721 Sunset Blvd
Suite a
Lexington, SC 29072-9151

Mailing address

P.O. Box 843384
Boston, MA 02284-3384
Phone (803) 227-8007

Other identifiers 4

IdentifierTypeStateIssuer
DM0194OtherSCMEDICAID DME#
PA0686MedicaidSC
14979900001OtherSCMEDICARE DME#
570521956-009OtherSCBC/BS PROVIDER #

Other names 1

  • Moore Orthopaedic Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Moore Orthopaedic Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2585/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277769600000",
    "number": "1285674572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 843384",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022843384",
            "telephone_number": "803-227-8007",
            "fax_number": "803-996-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 SUNSET BLVD",
            "address_2": "SUITE A",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290729151",
            "telephone_number": "803-227-8007",
            "fax_number": "803-996-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ORTHOPAEDIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2010-06-29",
        "status": "A",
        "authorized_official_last_name": "MCNALLY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-227-8152",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "SC",
            "license": "570521956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME#",
            "identifier": "DM0194",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA0686",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME#",
            "identifier": "14979900001",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER #",
            "identifier": "570521956-009",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore Orthopaedic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.