Mickelle O'Nea Pitt

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9163 Issued in SC

Practice address

1121 Broad St
Sumter, SC 29150-1902

Phone

(803) 590-3040

NPI assigned

Jul 3, 2018

Last updated

May 1, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1530576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588291200000",
    "number": "1730675653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 DEPOT ST APT 308",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012273",
            "telephone_number": "252-525-8365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 BROAD ST",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291501902",
            "telephone_number": "803-590-3040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5232 Sunset Blvd Ste C",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "SC",
            "postal_code": "290729347",
            "country_code": "US",
            "telephone_number": "252-525-8365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PITT",
        "first_name": "MICKELLE",
        "middle_name": "O'NEA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-03",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "DGD9163GD",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "9163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Piggly Wiggly South Inc (Sup RX Pharmacy)
• Jennifer T Pilot
• Pinewood Opco LLC (Pinewood Center for Rehabilitation and Healthcare)
• Omar Adolio Pinilla, M.D,
• Vijay Paul Pinto, M.D.
• Yvonne Pittman
• Plastic & Reconstructive Surgery of Sumter, PA
• Play Therapy of Sumter
• Lisbeth W Poag, DMD
• Brianna Polson

• General Practice Dentistry in Sumter, SC
• Providers in Sumter, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.