NPIMap

Organization Active NPI

North Augusta Pediatrics LLC

  • Pediatrics Physician
  • North Augusta, SC
National Provider Identifier
1700068293
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NORTH AUGUSTA PEDIATRICS LLC
Practice address
140 Allen Court
North Augusta, SC 29860
Phone
(803) 510-0007
Fax
(803) 510-0144
NPI assigned
Nov 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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

Authorized official

Name
Dr. John David Allen, M.D.NPI 1386628907
Title
Owner
Phone
(803) 510-0007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

140 Allen Court
North Augusta, SC 29860

Mailing address

140 Allen Court
North Augusta, SC 29860
Phone (803) 510-0007

Other identifiers 1

IdentifierTypeStateIssuer
GPA917MedicaidSC

Other names 1

  • North Augusta Pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190628000720 SC Part A Provider - Rural Health Clinic 0143554865 Practice locations: North Augusta, SC
O20210324002204 SC Part B Supplier - Mass Immunization (Roster Biller Only) 0143554865 Practice locations: North Augusta, SC

Rural health clinic certification: CCN 873804

Legal name
NORTH AUGUSTA PEDIATRICS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 2021
Last certification
Aug 11, 2021
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
140 Allen CT
North Augusta, SC 29860-9782

National Provider Directory

National Provider Directory
Tax ID family
North Augusta Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

140 Allen Ct
North Augusta, SC 29860
Phone (803) 510-0007

536 W Martintown Rd
North Augusta, SC 29841
Phone (803) 510-0007

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Katherine Dangerfield Individual W-2 Managing EmployeeOffice Manager Apr 16, 2019 75%
John Allen Individual 5% Or Greater Direct Ownership Interest Dec 16, 2005

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1700068293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 ALLEN COURT",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "29860",
            "telephone_number": "803-510-0007",
            "fax_number": "803-510-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 ALLEN COURT",
            "city": "NORTH AUGUSTA",
            "state": "SC",
            "postal_code": "29860",
            "telephone_number": "803-510-0007",
            "fax_number": "803-510-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH AUGUSTA PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-510-0007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPA917",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Augusta Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Augusta, SC

Sources for this page

Verify at the official NPI Registry.