NPIMap

Organization Active NPI

Prisma Health Medical Group-Midlands

  • Plastic and Reconstructive Surgery Physician
  • Sumter, SC
National Provider Identifier
1447749510
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
PRISMA HEALTH MEDICAL GROUP-MIDLANDS
Practice address
115 N Sumter St Ste 115
Sumter, SC 29150-4968
Phone
(803) 774-7546
Fax
(803) 774-9735
NPI assigned
May 4, 2018
Last updated
Dec 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Authorized official

Name
Kristi Lawrence
Title
Director Provider Enrollment
Phone
(864) 797-6118

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Plastic and Reconstructive Surgery Physician 2086S0122X SC Primary

Addresses

Primary practice location

115 N Sumter St Ste 115
Sumter, SC 29150-4968

Mailing address

PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320

Other practice location 1

738 W Liberty St Ste A
Sumter, SC 29150-4745
Phone (803) 775-6374

Other identifiers 1

IdentifierTypeStateIssuer
GP8508MedicaidSC

Other names 1

  • PH Medical Group Midlands Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160802001226 SC Part B Supplier - Clinic/Group Practice 5991099707 Receives reassigned benefits from 1,594 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1301 Taylor St
Ste 1A
Columbia, SC 29201
Phone (803) 254-4591

14 Richland Medical Park Dr
Ste 320
Columbia, SC 29203
Phone (803) 434-1663

3 Richland Medical Park Dr
Ste 330
Columbia, SC 29203
Phone (803) 434-7100

4 Medical Park Rd
Columbia, SC 29203
Phone (803) 434-2020

1079 Dutch Fork Rd
Irmo, SC 29063
Phone (803) 749-8900

115 N Sumter St
Ste 200
Sumter, SC 29150
Phone (803) 775-8351

Practitioners & affiliated clinicians

Practitioners 83

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.

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1447749510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904",
            "telephone_number": "803-296-7320",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N SUMTER ST STE 115",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504968",
            "telephone_number": "803-774-7546",
            "fax_number": "803-774-9735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "738 W Liberty St Ste A",
            "address_purpose": "LOCATION",
            "city": "Sumter",
            "state": "SC",
            "postal_code": "291504745",
            "country_code": "US",
            "telephone_number": "803-775-6374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRISMA HEALTH MEDICAL GROUP-MIDLANDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-04",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_title_or_position": "DIRECTOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "864-797-6118"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8508",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PH Medical Group Midlands",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sumter, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; 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.

Verify at the official NPI Registry.