Active NPI
Pramila Gajanan Shanbhag, MD
- Family Medicine Physician
- Woodruff, SC
National Provider Identifier
1487612412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 11750
- Practice address
- 511 Cross Anchor Rd
Woodruff, SC 29388-2328 - Phone
- (864) 476-8195
- Fax
- (864) 476-3084
- NPI assigned
- May 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11750 | SC | Primary |
Addresses
Primary practice location
511 Cross Anchor Rd
Woodruff, SC 29388-2328
Mailing address
511 Cross Anchor Rd
Woodruff, SC 29388-2328
Phone (864) 476-8195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 117509 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11750 | SC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487612412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 CROSS ANCHOR RD",
"city": "WOODRUFF",
"state": "SC",
"postal_code": "293882328",
"telephone_number": "864-476-8195",
"fax_number": "864-476-3084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 CROSS ANCHOR RD",
"city": "WOODRUFF",
"state": "SC",
"postal_code": "293882328",
"telephone_number": "864-476-8195",
"fax_number": "864-476-3084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANBHAG",
"first_name": "PRAMILA",
"middle_name": "GAJANAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "11750",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "117509",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodruff, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.