Organization Active NPI

Grace Medical Group, LLC

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1346468204
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GRACE MEDICAL GROUP, LLC
Practice address
3025 Farrow Rd
Columbia, SC 29203
Phone
(803) 933-0288
Fax
(803) 933-9920
NPI assigned
Apr 23, 2007
Last updated
Aug 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
Dr. Cynthia Mathews-Betts, MD
Title
MD
Phone
(803) 933-0288

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X 12184 SC
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 13924 SC

Addresses

Primary practice location

3025 Farrow Rd
Columbia, SC 29203

Mailing address

3025 Farrow Rd
Columbia, SC 29203
Phone (803) 933-0288

Other identifiers 1

IdentifierTypeStateIssuer
GP3812MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000425 SC Part B Supplier - Clinic/Group Practice 0345149894 Receives reassigned benefits from 3 practitioners
Practice locations: Columbia, SC

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1018654Grace Medical Group LLC3025 Farrow Road, Columbia, SC 29203Provider-performed microscopyOct 27, 2027

National Provider Directory

National Provider Directory

Locations

1333 Taylor St
Ste 3B
Columbia, SC 29201
Phone (803) 933-0288

3025 Farrow Rd
Columbia, SC 29203
Phone (803) 509-5676

Practitioners & affiliated clinicians

Practitioners 3

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": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1346468204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3025 FARROW RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-933-0288",
            "fax_number": "803-933-9920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 FARROW RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-933-0288",
            "fax_number": "803-933-9920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "MATHEWS-BETTS",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "803-933-0288",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "SC",
            "license": "12184",
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "SC",
            "license": "13924",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3812",
            "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 Aug 17, 2023; 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.