Matthew Pham

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

10002 Issued in SC

Practice address

3573 Sunset Blvd
West Columbia, SC 29169-3043

Phone

(803) 973-4530

NPI assigned

Apr 29, 2015

Last updated

Nov 22, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 20, 2021 through Mar 20, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• DRS Farrell, Farrell, Nale, Cook, Kapitan, Mohamed, Franco, Wessel, Ho

  dba Carolinas Center For Oral And Facial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Rock Hill, SC
  • NPI 1861913022
  NPD (past)
• DRS Farrell, Farrell, Nale, Cook, Kapitan, Mohamed, Franco, Wessel, Ho

  dba Carolinas Center For Oral And Facial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Charlotte, NC
  • NPI 1972554186

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1700263779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MANNING DR",
            "address_2": "149 BRAUER HALL,",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "27514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3573 SUNSET BLVD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291693043",
            "telephone_number": "803-973-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-29",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "10002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pets Inc Pharmacy (The Farmacy at PETSinc)
• Hannah Elizabeth Pettigrew
• Ronin Bates Pettit
• Andrea M Pezzella, MD
• Linda Chang Schelle Pham, M.M.S., PA-C
• Phenomenal Paths Counseling LLC
• Scott D. Phifer, PTA
• Courtney Nicole Phillips
• James Horace Phillips Jr., RPH
• Edwin Potes Pia, M.D.

• Oral and Maxillofacial Surgery (Dentist) in West Columbia, SC
• Providers in West Columbia, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.