NPIMap

Individual provider Active NPI

Roger A Gaddy, MD

  • Family Medicine Physician
  • Winnsboro, SC
National Provider Identifier
1669495917
Registry record updated Feb 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
8424 Issued in SC
Practice address
880 W Moultrie St
Suite 200
Winnsboro, SC 29180-5218
Phone
(803) 635-6461
Fax
(803) 635-4200
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2015

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 8424 SC Primary

Addresses

Primary practice location

880 W Moultrie St
Suite 200
Winnsboro, SC 29180-5218

Mailing address

PO Box 1218
Winnsboro, SC 29180-5218
Phone (803) 635-6461

Other identifiers 1

IdentifierTypeStateIssuer
084241MedicaidSC

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
I20100812000283 SC Practitioner - Family Practice 1658281480 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairfield Medical Associates, PA.Group PAC ID 3072519289, 3 clinicians

Practice addresses (Care Compare)

880 W Moultrie St
Suite 200
Winnsboro, SC 29180-2411
Phone 8036356461122

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue39

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8424SCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfield Medical Associates, LLC Family Medicine CurrentSince May 1, 1999 Accepting new patients
Physician's Pain and Spine Center, LLC PastSince May 1, 1999 Accepting new patients

Locations

880 W Moultrie St
#200
Winnsboro, SC 29180
Phone (803) 635-6461

Interoperability endpoints

  • Direct secure messaging: roger.gaddy@fmasc.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fairfield Medical Associates, PA.Winnsboro, SC, CCN 423840 Rural health clinic 5% Or Greater Direct Ownership Interest
Corporate Director		 Sep 14, 2010
Sep 14, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424995200000",
    "number": "1669495917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1218",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291805218",
            "telephone_number": "803-635-6461",
            "fax_number": "803-635-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 W MOULTRIE ST",
            "address_2": "SUITE 200",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291805218",
            "telephone_number": "803-635-6461",
            "fax_number": "803-635-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADDY",
        "first_name": "ROGER",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2015-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "8424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084241",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winnsboro, SC

Sources for this page

Verify at the official NPI Registry.