Individual provider Active NPI

Kathryn Anne Stephenson, MD

  • Pediatrics Physician
  • Columbia, SC
National Provider Identifier
1619905809
Registry record updated Apr 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
17543 Issued in SC
Practice address
14 Richland Medical Park Dr Ste 310
Columbia, SC 29203-6883
Phone
(803) 434-2300
Fax
(803) 434-8686
NPI assigned
Jun 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 17543 SC Primary

Addresses

Primary practice location

14 Richland Medical Park Dr Ste 310
Columbia, SC 29203-6883

Mailing address

PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320

Other identifiers 1

IdentifierTypeStateIssuer
175438MedicaidSC

Other names 1

  • Dr. Kathryn A Hickman Other name

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
I20100728001088 SC Practitioner - Pediatric Medicine 0840323713 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17543SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands Pediatrics Current Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Sep 23, 2016 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Sep 23, 2016 Accepting new patients
Prisma Health-Midlands Past Accepting new patients
Prisma Health-Midlands Past Accepting new patients

Locations

1333 Taylor St
Ste 3D
Columbia, SC 29201
Phone (803) 254-5575

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

14 Richland Medical Park Dr
Ste 310
Columbia, SC 29203
Phone (803) 252-9907

3555 Harden Street Ext
Ste 300
Columbia, SC 29203
Phone (803) 434-6411

Interoperability endpoints

  • Direct secure messaging: kstephenson384738@direct.ghs.myhfn.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522713600000",
    "number": "1619905809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904",
            "telephone_number": "803-296-7320",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 RICHLAND MEDICAL PARK DR STE 310",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036883",
            "telephone_number": "803-434-2300",
            "fax_number": "803-434-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENSON",
        "first_name": "KATHRYN",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2018-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "17543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175438",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "HICKMAN",
            "middle_name": "A",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.