Active NPI
Francis Marion University
- Psychologist
- Florence, SC
National Provider Identifier
1366033607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Legal business name
- FRANCIS MARION UNIVERSITY
- Practice address
- 201 W Evans St
Florence, SC 29501-3427 - Phone
- (843) 661-1721
- NPI assigned
- Jan 29, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jamie Lea Forthman
- Title
- Credentialing Manager
- Phone
- (270) 557-6396
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Psychologist | 103T00000X | Primary | ||
| Cognitive & Behavioral Psychologist | 103TB0200X | |||
| Clinical Psychologist | 103TC0700X | |||
| Clinical Child & Adolescent Psychologist | 103TC2200X | |||
| Health Psychologist | 103TH0004X | |||
| School Psychologist | 103TS0200X |
Addresses
Primary practice location
201 W Evans St
Florence, SC 29501-3427
Mailing address
PO Box 100547
Florence, SC 29502-0547
Other practice location 1
4822 E Palmetto St
Florence, SC 29506-4530
Phone (843) 661-1123
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210616001061 | SC | Part B Supplier - Clinic/Group Practice | 6800296690 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment Practice locations: Florence, SC |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Francis Marion University
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Speech-Language Pathologist
- Florence, SC
- NPI 1538750880
-
- Orthopaedic Surgery Physician
- Florence, SC
- NPI 1972047215
Practitioners & affiliated clinicians
Practitioners 7
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Speech-Language Pathologist
- Florence, SC
- NPI 1326412164
-
- Behavior Analyst
- Florence, SC
- NPI 1194280040
-
- Behavior Analyst
- Florence, SC
- NPI 1982100046
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611878400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1617753600000",
"number": "1366033607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 100547",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295020547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 W EVANS ST",
"city": "FLORENCE",
"state": "SC",
"postal_code": "295013427",
"telephone_number": "843-661-1721"
}
],
"practiceLocations": [
{
"address_1": "4822 E Palmetto St",
"address_purpose": "LOCATION",
"city": "Florence",
"state": "SC",
"postal_code": "295064530",
"country_code": "US",
"telephone_number": "843-661-1123",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "FRANCIS MARION UNIVERSITY",
"organizational_subpart": "NO",
"enumeration_date": "2021-01-29",
"last_updated": "2021-04-07",
"certification_date": "2021-04-07",
"status": "A",
"authorized_official_last_name": "FORTHMAN",
"authorized_official_first_name": "JAMIE",
"authorized_official_middle_name": "LEA",
"authorized_official_title_or_position": "CREDENTIALING MANAGER",
"authorized_official_telephone_number": "270-557-6396"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
},
{
"code": "103TB0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florence, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.