Active NPI
Devanand Anthony Dominique, MD
- Neurological Surgery Physician
- Columbia, SC
National Provider Identifier
1477541456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- License
- MD420830
- Practice address
- 3 Richland Medical Park Dr Ste 310
Columbia, SC 29203-6862 - Phone
- (803) 434-8323
- Fax
- (803) 434-8326
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | 61330 | SC | |
| Neurological Surgery Physician | 207T00000X | MD420830 | PA | Primary |
Addresses
Primary practice location
3 Richland Medical Park Dr Ste 310
Columbia, SC 29203-6862
Mailing address
300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD420830 | PA | MD | Neurological Surgery Physician |
| 61330 | SC | MD | Neurological Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Family Care, Inc | Current | Accepting new patients | |
| Musc Community Physicians | Current | Accepting new patients | |
| Musc Community Physicians | Current | Accepting new patients | |
| Neurospine Associates PC | Neurological Surgery | Current | Accepting new patients |
| Carolina Family Care, Inc | Current | Accepting new patients | |
| Pennsylvania Neurosurgery and Neuroscience Institute, Inc. | Neurological Surgery | Past | Accepting new patients |
Locations
506 North St
Bamberg, SC 29003
Phone (803) 245-6290
805 Pamplico Hwy
Florence, SC 29505
Phone (843) 674-2500
1341 Old Georgetown Rd
Ste C
Mt Pleasant, SC 29464
Phone (843) 884-2175
Interoperability endpoints
- ddominique736610@direct.ghs.myhfn.org
Organizations & group practices 6
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.
-
- Family Medicine Physician
- Charleston, SC
- NPI 1184655722
-
- Internal Medicine Physician
- Bamberg, SC
- NPI 1841878006
-
- Neurological Surgery Physician
- Harrisburg, PA
- NPI 1275878571
-
- Internal Medicine Physician
- Lancaster, SC
- NPI 1275564098
-
- Rural Health Clinic/Center
- Bowman, SC
- NPI 1225735772
-
- Neurological Surgery Physician
- Harrisburg, PA
- NPI 1659317766
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694131200000",
"number": "1477541456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 E MCBEE AVE FL 4",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296012842",
"telephone_number": "864-522-8603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 RICHLAND MEDICAL PARK DR STE 310",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292036862",
"telephone_number": "803-434-8323",
"fax_number": "803-434-8326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINIQUE",
"first_name": "DEVANAND",
"middle_name": "ANTHONY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-12",
"last_updated": "2023-09-08",
"certification_date": "2023-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "SC",
"license": "61330",
"primary": false
},
{
"code": "207T00000X",
"taxonomy_group": "",
"desc": "Neurological Surgery",
"state": "PA",
"license": "MD420830",
"primary": true
}
],
"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 Sep 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.