NPIMap

Individual provider Active NPI

Glen N Dougherty Jr., MD

  • Cardiovascular Disease Physician
  • Columbia, SC
National Provider Identifier
1720021553
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
28734 Issued in SC
Practice address
2001 Laurel St
Columbia, SC 29204-1018
Phone
(803) 254-3278
Fax
(803) 929-3256
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 28734 SC Primary

Addresses

Primary practice location

2001 Laurel St
Columbia, SC 29204-1018

Mailing address

PO Box 935722
Atlanta, GA 31193-5722
Phone (843) 792-6200

Other identifiers 1

IdentifierTypeStateIssuer
287344MedicaidSC

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
I20060712000317 SC Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0042228330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of South Carolina School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

1045 W Dekalb St
Camden, SC 29020-4162
Phone (843) 792-1414

108 Palmetto Park Blvd
Suite C
Lexington, SC 29072-7969
Phone (803) 356-0949

114 Gateway Corp Blvd
Columbia, SC 29203-9785

120 Gateway Corp Blvd
Columbia, SC 29203-9611
Phone (803) 432-4311

1315 Roberts St
Camden, SC 29020-3737
Phone (803) 432-4311

1524 Barnwell Hwy
Denmark, SC 29042-9410
Phone (843) 792-1414

1655 Bernardin Ave
Suite 350a
Columbia, SC 29204-2039
Phone (843) 792-1414

2001 Laurel St
Columbia, SC 29204-1018

2435 Forest Dr
Columbia, SC 29204-2026
Phone (803) 256-5300

2750 Laurel St
Suite 104
Columbia, SC 29204-2036
Phone (843) 792-1414

506 N St
Bamberg, SC 29003-1319
Phone (803) 245-6290

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair1-10
Varicose vein removal31

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Aug 1, 2021 Accepting new patients
Musc Community Physicians CurrentSince Aug 1, 2021 Accepting new patients
Musc Community Physicians Current Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1045 W DeKalb St
#A
Camden, SC 29020
Phone (803) 432-8622

1330 Haile St
Camden, SC 29020
Phone (803) 432-6771

1315 Roberts St
Camden, SC 29020
Phone (803) 432-4311

2351 Augusta Hwy
Lexington, SC 29072
Phone (803) 359-2486

1175 Cook Rd
Ste 230
Orangeburg, SC 29118
Phone (803) 395-3844

Interoperability endpoints

  • Direct secure messaging: gdougherty379593@direct.musc.edu

Organizations & group practices 4

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1720021553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 935722",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311935722",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 LAUREL ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292041018",
            "telephone_number": "803-254-3278",
            "fax_number": "803-929-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "GLEN",
        "middle_name": "N",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SC",
            "license": "28734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287344",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.