NPIMap

Organization Active NPI

South Carolina Oncology Assoc PA

  • Hematology & Oncology Physician
  • Columbia, SC
National Provider Identifier
1467406918
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
SOUTH CAROLINA ONCOLOGY ASSOC PA
Practice address
166 Stoneridge Dr
South Carolina Oncology Assoc
Columbia, SC 29210
Phone
(803) 461-3000
Fax
(803) 461-4917
NPI assigned
May 20, 2006
Last updated
Jun 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

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

Authorized official

Name
Dr. Fred J Kudrik, MDNPI 1104807668
Title
President
Phone
(803) 461-3000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X Primary
Gynecologic Oncology Physician 207VX0201X
Radiation Oncology Physician 2085R0001X

Addresses

Primary practice location

166 Stoneridge Dr
South Carolina Oncology Assoc
Columbia, SC 29210

Mailing address

PO Box 2046
West Columbia, SC 29171
Phone (803) 461-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000064 SC Part B Supplier - Clinic/Group Practice 6103739024 Receives reassigned benefits from 37 practitioners
Practice locations: Columbia, SC
O20100930002604 SC DME Supplier - Physician - Hematology/OncologyDME Supplier - Pharmacy 6103739024 Practice locations: Columbia, SC

National Provider Directory

National Provider Directory

Locations

166 Stoneridge Dr
Columbia, SC 29210
Phone (803) 296-5954

120 W Hospital Dr
West Columbia, SC 29169
Phone (803) 739-6500

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1467406918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2046",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "29171",
            "telephone_number": "803-461-3000",
            "fax_number": "803-461-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 STONERIDGE DR",
            "address_2": "SOUTH CAROLINA ONCOLOGY ASSOC",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29210",
            "telephone_number": "803-461-3000",
            "fax_number": "803-461-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA ONCOLOGY ASSOC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "KUDRIK",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-461-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jun 30, 2023; 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.