NPIMap

Organization Active NPI

Providence Family Practice LLC

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1528066115
Registry record updated Jun 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
8387 Issued in SC
Legal business name
PROVIDENCE FAMILY PRACTICE LLC
Practice address
2750 Laurel St
Suite 103
Columbia, SC 29204-2023
Phone
(803) 254-5171
Fax
(803) 779-7403
NPI assigned
Jul 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2010

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

Authorized official

Name
Frampton W Henderson Jr., M.D.NPI 1407802184
Title
Managing Partner
Phone
(803) 254-5171

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 8387 SC Primary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 13507 SC
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 21987 SC

Addresses

Primary practice location

2750 Laurel St
Suite 103
Columbia, SC 29204-2023

Mailing address

2750 Laurel St
Suite 103
Columbia, SC 29204-2038
Phone (803) 254-5171

Other identifiers 2

IdentifierTypeStateIssuer
GP2164MedicaidSC
CM5571OtherSCRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060123000299 SC Part B Supplier - Clinic/Group Practice 4284658865 Receives reassigned benefits from 6 practitioners
Practice locations: Columbia, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277251200000",
    "number": "1528066115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042038",
            "telephone_number": "803-254-5171",
            "fax_number": "803-779-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 LAUREL ST",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042023",
            "telephone_number": "803-254-5171",
            "fax_number": "803-779-7403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2010-06-23",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "FRAMPTON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "803-254-5171",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "8387",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "13507",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "21987",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2164",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CM5571",
            "state": "SC"
        }
    ],
    "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 Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.