Individual provider Active NPI

Kishan Vinesh Kumar, MD

  • Pediatrics Physician
  • Columbia, SC
National Provider Identifier
1639676679
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
89147 Issued in SC
Practice address
4605 Monticello Rd Ste 1
Columbia, SC 29203-4156
Phone
(803) 252-7001
Fax
(803) 252-5219
NPI assigned
Apr 6, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 89147 SC Primary

Addresses

Primary practice location

4605 Monticello Rd Ste 1
Columbia, SC 29203-4156

Mailing address

4605 Monticello Rd Ste 1
Columbia, SC 29203-4156
Phone (803) 252-7001

Other practice location 1

1000 Whaley St Apt 1094
Columbia, SC 29201-4278
Phone (525) 608-7473

Other practice location 2

121 Dekalb Ave
Brooklyn, NY 11201-5493
Phone (718) 250-6857

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230419001633 SC Practitioner - Pediatric Medicine 7810234994 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Eau Claire Cooperative Health Center, Inc. Pediatrics CurrentSince Jan 5, 2023 Accepting new patients
Eau Claire Cooperative Health Center ,Inc. CurrentSince Jan 5, 2023 Accepting new patients
Pratt Urology Associates, Inc Past Accepting new patients
Pediatrics of Newberry, LLC Pediatrics PastSince Jan 22, 2023 Accepting new patients

Locations

169 Laurelhurst Ave
Columbia, SC 29210
Phone (803) 730-0742

4605 Monticello Rd
Columbia, SC 29203
Phone (803) 252-7001

4605 Monticello Rd
Ste 1
Columbia, SC 29203
Phone (803) 252-7001

Interoperability endpoints

  • Direct secure messaging: kkumar11133@prd.direct.tbh.org

Organizations & group practices 4

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": "1522972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1639676679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 MONTICELLO RD STE 1",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292034156",
            "telephone_number": "803-252-7001",
            "fax_number": "803-252-5219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 MONTICELLO RD STE 1",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292034156",
            "telephone_number": "803-252-7001",
            "fax_number": "803-252-5219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Whaley St Apt 1094",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292014278",
            "country_code": "US",
            "telephone_number": "525-608-7473",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "121 Dekalb Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112015493",
            "country_code": "US",
            "telephone_number": "718-250-6857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUMAR",
        "first_name": "KISHAN",
        "middle_name": "VINESH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-06",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "89147",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 19, 2023; 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.