Active NPI
Stephanie Lauren Rose, D.O.
- Emergency Medicine Physician
- West Columbia, SC
National Provider Identifier
1659620250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- ED0319A
- Practice address
- 2720 Sunset Blvd
West Columbia, SC 29169-4810 - Phone
- (803) 791-2000
- NPI assigned
- Aug 29, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | ED0319A | WV | Primary |
Addresses
Primary practice location
2720 Sunset Blvd
West Columbia, SC 29169-4810
Mailing address
2000 Eoff Street
Wheeling, WV 26003
Other practice location 1
612 Mocksville Ave
Salisbury, NC 28144-2732
Phone (704) 210-5335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251222003171 | NC | Order and Referring Only - Emergency Medicine | 1759681547 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ED0319A | WV | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613347200000",
"number": "1659620250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 EOFF STREET",
"city": "WHEELING",
"state": "WV",
"postal_code": "26003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 SUNSET BLVD",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291694810",
"telephone_number": "803-791-2000"
}
],
"practiceLocations": [
{
"address_1": "612 Mocksville Ave",
"address_purpose": "LOCATION",
"city": "Salisbury",
"state": "NC",
"postal_code": "281442732",
"country_code": "US",
"telephone_number": "704-210-5335",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROSE",
"first_name": "STEPHANIE",
"middle_name": "LAUREN",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-29",
"last_updated": "2021-02-15",
"certification_date": "2021-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "WV",
"license": "ED0319A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in West Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.