NPIMap

Individual provider Active NPI

Mark Edward Shaffer, MD

  • Family Medicine Physician
  • Winnsboro, SC
National Provider Identifier
1639308380
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
31836 Issued in SC
Practice address
56 US Highway 321 Byp N
Winnsboro, SC 29180-7100
Phone
(803) 635-6099
Fax
(803) 635-6343
NPI assigned
Jul 2, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 31836 SC Primary

Addresses

Primary practice location

56 US Highway 321 Byp N
Winnsboro, SC 29180-7100

Mailing address

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

Other practice location 1

3209 Colonial Dr
Family Medicine
Columbia, SC 29203-6930
Phone (803) 434-6113

Other practice location 2

3209 Colonial Dr
Family Medicine
Columbia, SC 29203-6930
Phone (803) 434-6113

Other identifiers 1

IdentifierTypeStateIssuer
318365MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mshaffer384258@direct.ghs.myhfn.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150216000865 SC Practitioner - Family Practice 2961727953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Harvard Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

3209 Colonial Dr
Columbia, SC 29203-6930
Phone (803) 434-6113

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31836SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands Family Medicine CurrentSince Oct 28, 2016 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Oct 28, 2016 Accepting new patients
Prisma Health-Midlands Past Accepting new patients

Locations

3209 Colonial Dr
Columbia, SC 29203
Phone (803) 434-6113

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

56 US Highway 321 Byp N
Winnsboro, SC 29180
Phone (803) 635-6099

Interoperability endpoints

  • Direct secure messaging: mshaffer384258@direct.ghs.myhfn.org

Organizations & group practices 3

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 10

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": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1639308380",
    "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": "56 US HIGHWAY 321 BYP N",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291807100",
            "telephone_number": "803-635-6099",
            "fax_number": "803-635-6343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3209 Colonial Dr",
            "address_2": "Family Medicine",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292036930",
            "country_code": "US",
            "telephone_number": "803-434-6113",
            "fax_number": "803-434-7231",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3209 Colonial Dr",
            "address_2": "Family Medicine",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292036930",
            "country_code": "US",
            "telephone_number": "803-434-6113",
            "fax_number": "803-434-7231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-02",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "31836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "318365",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mshaffer384258@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mshaffer384258@direct.ghs.myhfn.org",
            "address_1": "56 US Highway 321 Byp N",
            "city": "Winnsboro",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291807100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winnsboro, SC

Sources for this page

Verify at the official NPI Registry.