NPIMap

Organization Active NPI

Palmetto Health - University of South Carolina Medical Group

  • Family Medicine Physician
  • Sumter, SC
National Provider Identifier
1295211894
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP
Practice address
115 N Sumter St Ste 315
Sumter, SC 29150-4967
Phone
(803) 934-0810
Fax
(803) 934-0809
NPI assigned
Jul 17, 2018
Last updated
Jul 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Authorized official

Name
William D. Anderson III,
Title
Chief Medical Officer
Phone
(803) 545-5005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X SC Primary

Addresses

Primary practice location

115 N Sumter St Ste 315
Sumter, SC 29150-4967

Mailing address

PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160802001226 SC Part B Supplier - Clinic/Group Practice 5991099707 Receives reassigned benefits from 1,594 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

100 Palmetto Health Pkwy
Ste G100
Columbia, SC 29212
Phone (803) 296-3273

3 Richland Medical Park Dr
Ste 120
Columbia, SC 29203
Phone (803) 434-8866

720 Gracern Rd
Ste 120
Columbia, SC 29210
Phone (803) 296-2585

115 N Sumter St
Ste 315
Sumter, SC 29150
Phone (803) 774-9787

103 Saluda Ridge Ct
West Columbia, SC 29169
Phone (803) 794-3320

Practitioners & affiliated clinicians

Practitioners 81

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.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531785600000",
    "number": "1295211894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904",
            "telephone_number": "803-296-7320",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N SUMTER ST STE 315",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504967",
            "telephone_number": "803-934-0810",
            "fax_number": "803-934-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO HEALTH - UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-17",
        "last_updated": "2018-07-17",
        "status": "A",
        "authorized_official_last_name": "ANDERSON III,",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "803-545-5005"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumter, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; 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.