NPIMap

Organization Active NPI

Carolina Pediatrics & Adolescent Care, PA

  • Pediatrics Physician
  • Columbia, SC
National Provider Identifier
1306805056
Registry record updated Oct 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
12782 Issued in SC
Legal business name
CAROLINA PEDIATRICS & ADOLESCENT CARE, PA
Practice address
2113 Adams GRV
Suite 101
Columbia, SC 29203-7102
Phone
(803) 256-0531
Fax
(803) 765-9052
NPI assigned
Mar 21, 2006
Last updated
Oct 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2017

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

Authorized official

Name
Dr. Philip F. Mubarak, M. D.NPI 1316991961
Title
Physician
Phone
(803) 256-0531

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
Pediatrics Physician 208000000X 12782 SC Primary

Addresses

Primary practice location

2113 Adams GRV
Suite 101
Columbia, SC 29203-7102

Mailing address

2113 Adams GRV
Suite 101
Columbia, SC 29203-6951
Phone (803) 256-0531

Other identifiers 1

IdentifierTypeStateIssuer
GP0094MedicaidSC

National Provider Directory

National Provider Directory

Locations

2113 Adams Grv
Ste 101
Columbia, SC 29203
Phone (803) 256-0531

7033 Saint Andrews Rd
Ste 110
Columbia, SC 29212
Phone (803) 376-2838

Practitioners & affiliated clinicians

Practitioners 12

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": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507852800000",
    "number": "1306805056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2113 ADAMS GRV",
            "address_2": "SUITE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036951",
            "telephone_number": "803-256-0531",
            "fax_number": "803-765-9052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2113 ADAMS GRV",
            "address_2": "SUITE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292037102",
            "telephone_number": "803-256-0531",
            "fax_number": "803-765-9052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA PEDIATRICS & ADOLESCENT CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2017-10-13",
        "status": "A",
        "authorized_official_last_name": "MUBARAK",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "803-256-0531",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "12782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0094",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; 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.