Lake Carolina Pain and Spine Center, LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

23150 Issued in SC

Legal business name

LAKE CAROLINA PAIN AND SPINE CENTER, LLC

Practice address

1821 Clemson Rd
Columbia, SC 29229-7832

Phone

(803) 788-5916

Fax

(803) 788-9564

NPI assigned

Mar 2, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Kamran Z Koranloo, M.D.

Title

Physician

Phone

(803) 764-1228

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kamran Zargham Koranloo, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Columbia, SC
  • NPI 1013022516
  Medicare reassignment

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

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578268800000",
    "number": "1326430208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 CLEMSON RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292297832",
            "telephone_number": "803-788-5916",
            "fax_number": "803-788-9564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 CLEMSON RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292297832",
            "telephone_number": "803-788-5916",
            "fax_number": "803-788-9564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CAROLINA PAIN AND SPINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-02",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A",
        "authorized_official_last_name": "KORANLOO",
        "authorized_official_first_name": "KAMRAN",
        "authorized_official_middle_name": "Z",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "803-764-1228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "SC",
            "license": "23150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rushiraj Chaitanya Laiwala, M.D.
• Lake Psychological Services, LLC
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• Karen D Lake, PH.D
• Leah Johnson Lake, MED
• Gwendolyn Regina Lakin, LISW-CP

• Pain Medicine (Anesthesiology) Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Pain Medicine (Anesthesiology) Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.