Individual provider Active NPI

Sally Aleen Davidson, PA-C

  • Physician Assistant
  • Columbia, SC
National Provider Identifier
1598429003
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4211 Issued in SC
Practice address
500 Gills Creek Pkwy Apt 416
Columbia, SC 29209-1236
Phone
(919) 896-3955
Fax
(919) 896-3955
NPI assigned
Oct 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 4211 SC Primary

Addresses

Primary practice location

500 Gills Creek Pkwy Apt 416
Columbia, SC 29209-1236

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

3 Richland Medical Park Dr Ste 120
Columbia, SC 29203-6850
Phone (803) 434-8866

Other names 1

  • Miss Sally Aleen Hart Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230724002995 KY Practitioner - Physician Assistant 3678967767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

3900 Kresge Way
Louisville, KY 40207-4681

3950 Kresge Way
Louisville, KY 40207-4637

4002 Kresge Way
Suite 110
Louisville, KY 40207-4605
Phone (502) 928-8700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TC384KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Jul 11, 2023 Accepting new patients
Baptist Health Medical Group, Inc. Physician Assistant CurrentSince Jul 11, 2023 Accepting new patients

Locations

5200 Commerce Crossings Dr
Fl 3
Louisville, KY 40229
Phone (502) 253-4924

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

3950 Kresge Way
Ste 207
Louisville, KY 40207
Phone (502) 893-0220

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1635552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645660800000",
    "number": "1598429003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 GILLS CREEK PKWY APT 416",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292091236",
            "telephone_number": "919-896-3955",
            "fax_number": "919-896-3955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Richland Medical Park Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292036850",
            "country_code": "US",
            "telephone_number": "803-434-8866",
            "fax_number": "803-933-3049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "SALLY",
        "middle_name": "ALEEN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-30",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "HART",
            "middle_name": "ALEEN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.