NPIMap

Organization Active NPI

Prisma Health-Midlands

Doing business as Prisma Health Behavioral Care

  • Behavioral Neurology & Neuropsychiatry Physician
  • Columbia, SC
National Provider Identifier
1487078663
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
Legal business name
PRISMA HEALTH-MIDLANDS
Doing business as
Prisma Health Behavioral Care
Practice address
720 Gracern Rd
Suite 120
Columbia, SC 29210-7655
Phone
(803) 296-2585
Fax
(803) 551-1254
NPI assigned
Feb 10, 2014
Last updated
Nov 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

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

Authorized official

Name
Polly H Miller
Title
SVP Finance, Enterprise Contracting
Phone
(864) 522-2286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavioral Neurology & Neuropsychiatry Physician 2084B0040X NU Primary

Addresses

Primary practice location

720 Gracern Rd
Suite 120
Columbia, SC 29210-7655

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (803) 296-7305

Other identifiers 1

IdentifierTypeStateIssuer
GP6416MedicaidSC

Other names 1

  • Prisma Health Behavioral Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040512000745 SC Part B Supplier - Clinic/Group Practice 6800708330 Receives reassigned benefits from 4 practitioners
3 other NPIs on this enrollment
Practice locations: Columbia, SC

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Northeast Family Practi105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All facility ownership & control disclosures 11

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Prisma Health Baptist HospitalColumbia, SC, CCN 420086 Hospital Operational/Managerial Control (100%)
Other		 Apr 1, 2019
Apr 1, 2019
Prisma Health Richland HospitalColumbia, SC, CCN 420018 Hospital 5% Or Greater Direct Ownership Interest (100%)
Other		 Jan 7, 2013
Jan 7, 2013
Prisma Health Richland SpringsColumbia, SC, CCN 42S018 Hospital Operational/Managerial Control
Other		 Sep 26, 1993
Sep 26, 1993
Prisma Health Baptist ParkridgeColumbia, SC, CCN 420106 Hospital Operational/Managerial Control (100%)
Other		 Jan 14, 2014
Jan 14, 2014
Prisma Health Tuomey HospitalColumbia, SC, CCN 42S086 Hospital Operational/Managerial Control
Other		 Oct 1, 1990
Oct 1, 1990
Prisma Health Tuomey HospitalSumter, SC, CCN 420070 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2025
Prisma Health Home HealthColumbia, SC, CCN 427013 Home health agency Operational/Managerial Control (100%) Jan 1, 2007
Prisma Health Tuomey Home HealthSumter, SC, CCN 427078 Home health agency Other Jan 1, 2016
Prisma Health Tuomey HospiceSumter, SC, CCN 421509 Hospice Operational/Managerial Control
Other		 Jan 1, 2016
Jan 1, 2016
PH Family Medicine WinnsboroWinnsboro, SC, CCN 423496 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Family Medicine-BishopvilleBishopville, SC, CCN 423497 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019

Owned or controlled facilities with NPI records 18

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 18

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1391990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667952000000",
    "number": "1487078663",
    "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": "803-296-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 GRACERN RD",
            "address_2": "SUITE 120",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292107655",
            "telephone_number": "803-296-2585",
            "fax_number": "803-551-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH-MIDLANDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-10",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "SVP FINANCE, ENTERPRISE CONTRACTING",
        "authorized_official_telephone_number": "864-522-2286"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6416",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prisma Health Behavioral Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.