Envision Wellness Medical Group LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

ENVISION WELLNESS MEDICAL GROUP LLC

Practice address

4100 N Main St Ste 101
Columbia, SC 29203-5800

Phone

(803) 256-0101

Fax

(800) 854-3497

NPI assigned

Jan 3, 2023

Organization subpart

Yes

Parent organization

ENVISION WELLNESS MEDICAL GROUP LLCAs reported in NPPES

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

Authorized official

Name

Lisa Roberts

Title

Office Manager

Phone

(803) 256-0101

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Envision Wellness Medical Group IOP Doing business as

Electronic endpoints 1

Tax ID family

Envision Wellness Medical Group LLC2 organizations share this tax ID, including this one

Part of

Envision Wellness Medical Group LLC

Other organizations with this tax ID 1

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

• Envision Wellness Medical Group LLC

  • Child & Adolescent Psychiatry Physician
  • Columbia, SC
  • NPI 1043832157
  NPD tax ID

Practitioners 1

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

• Ayanna Swinton Jamison, M.D.

  • Child & Adolescent Psychiatry Physician
  • Columbia, SC
  • NPI 1053359851
  NPD (past)

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1710690912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 N MAIN ST STE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292035800",
            "telephone_number": "803-256-0101",
            "fax_number": "800-854-3497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 N MAIN ST STE 101",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292035800",
            "telephone_number": "803-256-0101",
            "fax_number": "800-854-3497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION WELLNESS MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ENVISION WELLNESS MEDICAL GROUP  LLC",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-256-0101"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PC0151",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "envisionmedicalgroup@gmail.com",
            "affiliation": "N",
            "address_1": "4100 N Main St Ste 101",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292035800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Envision Wellness Medical Group IOP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Towanna Shanett-Lance Enoch, NP-C
• Manuel Hipolito Enriquez, M.D.
• Envision Therapy Services, LLC
• Envision Wellness Medical Group
• Envision Wellness Medical Group LLC
• David Alan Eoute Jr., MSP, SLP-CFY
• Joanne B Epley, RPH
• Lindsay Benvenuto Eppehimer, APRN
• Maria N Eppig, D.O.
• Abreia Epps, ED.S LPC

• Psychiatry Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.