NPIMap

Organization Active NPI

Colonial Family Practice, LLC

Doing business as Colonial Family Practice Wesmark

  • Family Medicine Physician
  • Sumter, SC
National Provider Identifier
1497060719
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3006640 Issued in SC
Legal business name
COLONIAL FAMILY PRACTICE, LLC
Doing business as
Colonial Family Practice Wesmark
Practice address
308 W Wesmark Blvd
Sumter, SC 29150
Phone
(803) 773-5227
Fax
(803) 774-5400
NPI assigned
Aug 11, 2010
Last updated
Mar 22, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COLONIAL FAMILY PRACTICE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Authorized official

Name
Mrs. Stephanie K Disher
Title
Credentialing Specialist
Phone
(803) 773-5227

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 3006640 SC Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

308 W Wesmark Blvd
Sumter, SC 29150

Mailing address

325 Broad St
Suite 100
Sumter, SC 29150-4167
Phone (803) 773-5227

Other names 1

  • Colonial Family Practice Wesmark Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040727000107 SC Part B Supplier - Clinic/Group Practice 9931017118 Receives reassigned benefits from 88 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sumter, SC; Camden, SC; Manning, SC; Columbia, SC

Other NPIs on the same Medicare enrollment 13

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

View all 13

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
42D2011235Colonial Family Practice Wesmark308 Wesmark Blvd, Sumter, SC 29150Provider-performed microscopyAug 12, 2026

National Provider Directory

National Provider Directory
Part of
Colonial Family Practic

Locations

1013 Professional Ct
Ste A
Manning, SC 29102
Phone (803) 433-7425

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1497060719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 BROAD ST",
            "address_2": "SUITE 100",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504167",
            "telephone_number": "803-773-5227",
            "fax_number": "803-774-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 W WESMARK BLVD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "29150",
            "telephone_number": "803-773-5227",
            "fax_number": "803-774-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL FAMILY PRACTICE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLONIAL FAMILY PRACTICE, LLC",
        "enumeration_date": "2010-08-11",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "DISHER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "803-773-5227",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "3006640",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Family Practice Wesmark",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colonial Family Practice Wesmark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sumter, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.