Colonial Family Practice, LLC
Organization Active NPI Family Medicine Physician · Sumter, SC
NPI 1497060719 · NPPES record last updated Mar 22, 2021
Key facts
- NPI
- 1497060719
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 3006640 (SC)
- Legal business name
- COLONIAL FAMILY PRACTICE, LLC
- Practice address
- 308 W Wesmark Blvd
Sumter, SC 29150 - Phone
- (803) 773-5227
- Fax
- (803) 774-5400
- NPI assigned
- Aug 11, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- COLONIAL FAMILY PRACTICE, LLC
Authorized official
- Name
- Mrs. Stephanie K Disher
- Title
- Credentialing Specialist
- Phone
- (803) 773-5227
Other NPIs on the same Medicare enrollment 13
Practitioners 41
-
John Kenneth Baker, M.D.
-
Amber Nicole Ballentine, APRN
-
Dale Scurry Barwick, ANP
-
Cody Becksvoort, D.O
-
Steven Jon Bosc II, PA-C
-
Angel Jeanine Brown, APRN
-
Arika Y Bryant, PA-C
-
William Byrd, NP
-
Sherica Lynn Warfield Cain, FNP-C
-
Honey Dawn Chapman, DNP, APRN, FNP-C
-
Jaiwoo Chung, MD
-
Grace Wielicki Couch, FNP-C
-
Mary Kathleen Cox, FNP-C
-
Carmen Leticia Dominguez, M.D.
-
Wanda Kay Fulton, FNP-BC
-
Krystal Sherron Hill, NURSE PRACTITIONER
-
Michela Hopper, DNP
-
Carrie Anne Judy, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D2011235 | Colonial Family Practice Wesmark | Provider-performed microscopy | Aug 12, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Colonial Family Practice
Locations
26 Wesmark Ct
Sumter, SC 29150
Phone (803) 883-4981
308 W Wesmark Blvd
Sumter, SC 29150
Phone 80377352271013
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 3006640 | SC | Yes |
| Family Nurse Practitioner |
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
- Colonial Family Practice Wesmark
Other providers in Sumter, SC
- William A Collins III
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
All providers in Sumter, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.