NPIMap

Individual provider Active NPI

Gordon E Pennebaker, MD

  • Family Medicine Physician
  • Camden, SC
National Provider Identifier
1366494197
Registry record updated Feb 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
18265 Issued in SC
Practice address
1344 Haile St
Camden, SC 29020-3076
Phone
(803) 432-1996
Fax
(803) 424-2703
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 18265 SC Primary

Addresses

Primary practice location

1344 Haile St
Camden, SC 29020-3076

Mailing address

PO Box 1259
Sentinel Health Partners PA Business Office
Camden, SC 29021-1259
Phone (803) 713-8350

Other identifiers 3

IdentifierTypeStateIssuer
080181551OtherSCRAILROAD MEDICARE PIN
B5656OtherMEDCOST
182652MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050131000116 SC Practitioner - Family Practice 3870576994 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

1344 Haile St
Camden, SC 29020-3076
Phone (803) 432-8426

Hospital & facility affiliations

  • Amedisys Home Health of Camden Home health agency, Camden, SC, CCN 427036
  • Amedisys Home Health of Lexington Home health agency, Lexington, SC, CCN 427039
  • Kershawhealth Hospital, Camden, SC, CCN 420048
  • Musc Health Columbia Medical Center Downtown Hospital, Columbia, SC, CCN 420026
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy78
Upper gastrointestinal (GI) endoscopy for acid reflux24
Melanoma (skin cancer) excision1-10
Removal of skin lesions37
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians Current Accepting new patients
Musc Community Physicians Family Medicine CurrentSince Aug 1, 2021 Accepting new patients
Musc Community Physicians CurrentSince Aug 1, 2021 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients
B-L Family Practice P a Family Medicine Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1315 Roberts St
Camden, SC 29020
Phone (803) 432-4311

1344 Haile St
Camden, SC 29020
Phone (803) 254-3376

2001 Laurel St
Ste 300
Columbia, SC 29204
Phone (803) 254-2786

120 Gateway Corporate Blvd
Columbia, SC 29203
Phone (803) 256-5320

2689 Highway 1 S
Elgin, SC 29045
Phone (803) 438-7698

216 E Marion St
Kershaw, SC 29067
Phone (803) 475-3350

710 Dewitt Dr
Lugoff, SC 29078
Phone (803) 233-1730

Interoperability endpoints

  • Direct secure messaging: gpennebaker379635@direct.musc.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330041600000",
    "number": "1366494197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1259",
            "address_2": "SENTINEL HEALTH PARTNERS PA BUSINESS OFFICE",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290211259",
            "telephone_number": "803-713-8350",
            "fax_number": "803-713-8433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 HAILE ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290203076",
            "telephone_number": "803-432-1996",
            "fax_number": "803-424-2703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNEBAKER",
        "first_name": "GORDON",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "18265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "080181551",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "B5656",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182652",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, SC

Sources for this page

Verify at the official NPI Registry.