NPIMap

Individual provider Active NPI

Mark A Davis, MD

  • Internal Medicine Physician
  • Newberry, SC
National Provider Identifier
1457465916
Registry record updated May 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10491 Issued in SC
Practice address
2033 Medical Park Drive
Newberry, SC 29108
Phone
(803) 276-5188
Fax
(803) 276-9317
NPI assigned
Aug 19, 2006
Last updated
May 13, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 10491 SC Primary

Addresses

Primary practice location

2033 Medical Park Drive
Newberry, SC 29108

Mailing address

2033 Medical Park Drive
Newberry, SC 29108
Phone (803) 276-5188

Other identifiers 1

IdentifierTypeStateIssuer
6190MedicaidSC

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
I20040217000011 SC Practitioner - Internal Medicine 6901791292 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Miami, LM Miller School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newberry Internal Medicine LLCGroup PAC ID 9032186614, 2 clinicians

Practice addresses (Care Compare)

2033 Medical Park Dr
Newberry, SC 29108-2249
Phone (803) 276-5188

2669 Kinard St
Newberry, SC 29108-2911
Phone (803) 276-7570

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10491SCMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Newberry County Memorial Hospital CurrentSince Jan 1, 2003 Accepting new patients
Newberry County Memorial Hospital CurrentSince Jan 1, 2003 Accepting new patients

Locations

1830 Pondfield Rd
Ste A1
Newberry, SC 29108
Phone (803) 405-7140

2669 Kinard St
Newberry, SC 29108
Phone (803) 276-7570

Interoperability endpoints

  • Direct secure messaging: m.davis@new.directbygreenway.com

Organizations & group practices 3

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

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305244800000",
    "number": "1457465916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2033 MEDICAL PARK DRIVE",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "29108",
            "telephone_number": "803-276-5188",
            "fax_number": "803-276-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 MEDICAL PARK DRIVE",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "29108",
            "telephone_number": "803-276-5188",
            "fax_number": "803-276-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2011-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "10491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6190",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newberry, SC

Sources for this page

Verify at the official NPI Registry.