Individual provider Active NPI

Robert C Schnackenberg, MD

  • Psychiatry Physician
  • Columbia, SC
National Provider Identifier
1548240484
Registry record updated Jul 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
5816 Issued in SC
Practice address
1415 Blanding St
Suite 4
Columbia, SC 29201-2922
Phone
(803) 779-7500
Fax
(803) 779-7522
NPI assigned
Jan 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 24, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 5816 SC
Psychiatry Physician 2084P0800X 5816 SC Primary

Addresses

Primary practice location

1415 Blanding St
Suite 4
Columbia, SC 29201-2922

Mailing address

1415 Blanding St
Suite 4
Columbia, SC 29201-2922
Phone (803) 779-7500

Other identifiers 1

IdentifierTypeStateIssuer
058163MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100706000052 SC Practitioner - Psychiatry 1153452263 Practice locations: Columbia, SC

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Michigan Homeopathic Medical School, 1961
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1415 Blanding St
Suite 4
Columbia, SC 29201-2922
Phone 803779750040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5816SCMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437696000000",
    "number": "1548240484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 BLANDING ST",
            "address_2": "SUITE 4",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012922",
            "telephone_number": "803-779-7500",
            "fax_number": "803-779-7522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 BLANDING ST",
            "address_2": "SUITE 4",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012922",
            "telephone_number": "803-779-7500",
            "fax_number": "803-779-7522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHNACKENBERG",
        "first_name": "ROBERT",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2015-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "SC",
            "license": "5816",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "5816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058163",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.