NPIMap

Organization Active NPI

Palmetto Medical Group, PLLC

Doing business as Palmetto Medical Group

  • Internal Medicine Physician
  • Indian Land, SC
National Provider Identifier
1467629261
Registry record updated Aug 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PALMETTO MEDICAL GROUP, PLLC
Doing business as
Palmetto Medical Group
Practice address
1040 Edgewater Corporate Pkwy Suite 101
Indian Land, SC 29707-7177
Phone
(803) 548-7007
NPI assigned
May 12, 2008
Last updated
Aug 14, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
PALMETTO MEDICAL GROUP, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2015

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

Authorized official

Name
Dr. Amit G Shah, M.D.NPI 1740288323
Title
President
Phone
(803) 548-7007

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1040 Edgewater Corporate Pkwy Suite 101
Indian Land, SC 29707-7177

Mailing address

1040 Edgewater Corporate Pkwy Suite 101
Indian Land, SC 29707-7177
Phone (803) 548-7007

Other names 1

  • Palmetto Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081010000785 SC Part B Supplier - Clinic/Group Practice 5496823817 Receives reassigned benefits from 17 practitioners
Practice locations: Indian Land, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1054340Palmetto Medical Group, PLLC1040 Edgewater Corporate Pkwy, Suite 101, Indian Land, SC 29707Certificate of waiverMay 17, 2028

National Provider Directory

National Provider Directory
Part of
Palmetto Medical Group PLLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439510400000",
    "number": "1467629261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 EDGEWATER CORPORATE PKWY SUITE 101",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297077177",
            "telephone_number": "803-548-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 EDGEWATER CORPORATE PKWY SUITE 101",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297077177",
            "telephone_number": "803-548-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO MEDICAL GROUP, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALMETTO MEDICAL GROUP, PLLC",
        "enumeration_date": "2008-05-12",
        "last_updated": "2015-08-14",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "AMIT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-548-7007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmetto Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indian Land, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.