NPIMap

Organization Active NPI

Pediatric Associates PA

  • Pediatrics Physician
  • Camden, SC
National Provider Identifier
1730121179
Registry record updated Jan 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES PA
Practice address
1346 Haile St
Camden, SC 29020-3076
Phone
(803) 432-1931
Fax
(803) 432-1176
NPI assigned
Jun 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2013

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

Authorized official

Name
Mrs. Linda E Reed
Title
Office Manager
Phone
(803) 432-1931

Specialties & licenses 1

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

Addresses

Primary practice location

1346 Haile St
Camden, SC 29020-3076

Mailing address

1346 Haile St
Camden, SC 29020-3076
Phone (803) 432-1931

Other identifiers 7

IdentifierTypeStateIssuer
134795MedicaidSC
299073MedicaidSC
320352MedicaidSC
85357MedicaidSC
95612MedicaidSC
75867MedicaidSC
185551MedicaidSC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0248588Pediatric Associates, PA1346 Haile Street, Camden, SC 29020ComplianceNov 8, 2027

National Provider Directory

National Provider Directory

Locations

40 Pinnacle Pkwy
Ste 200
Elgin, SC 29045

40 Pinnacle Pkwy
Ste 206
Elgin, SC 29045
Phone (803) 438-3311

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359590400000",
    "number": "1730121179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1346 HAILE ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290203076",
            "telephone_number": "803-432-1931",
            "fax_number": "803-432-1176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1346 HAILE ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290203076",
            "telephone_number": "803-432-1931",
            "fax_number": "803-432-1176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2013-01-31",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-432-1931",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "134795",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299073",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320352",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85357",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95612",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75867",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185551",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.