Donna Grimsley Mizelle, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22449 Issued in SC

Practice address

25 East Clark Street
Pinewood, SC 29125

Phone

(803) 774-4500

Fax

(803) 452-5712

NPI assigned

Jun 17, 2006

Last updated

Oct 25, 2022By 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

Other identifiers 2

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Brody School of Medicine at East Carolina University, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tandem Health SCGroup PAC ID 3870575855, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prisma Health Tuomey Hospital Hospital, Sumter, SC, CCN 420070
• McLeod Health Clarendon Hospital, Manning, SC, CCN 420109

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: donna.mizelle.1@13095.direct.athenahealth.com

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.

• Tandem Health SC

  • Federally Qualified Health Center (FQHC)
  • Sumter, SC
  • NPI 1386630192
  Medicare reassignment Care Compare group NPD
• Tandem Health SC

  • Federally Qualified Health Center (FQHC)
  • Sumter, SC
  • NPI 1821885583
  NPD
• Self Regional Healthcare

  dba SRH Diabetes Education

  • Diabetes Educator Registered Nurse
  • Greenwood, SC
  • NPI 1417582503
  NPD (past)
• Tandem Health SC

  dba Sumter Family Health Center - Pinewood

  • Federally Qualified Health Center (FQHC)
  • Pinewood, SC
  • NPI 1811973068
  NPD (past)

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

• McLeod Health Clarendon

  • Rural Acute Care Hospital
  • Manning, SC
  • NPI 1205284411
  Care Compare affiliation
• Prisma Health-Midlands

  dba Prisma Health Tuomey Hosptial

  • General Acute Care Hospital
  • Sumter, SC
  • NPI 1326043548
  Care Compare affiliation

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1760427678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 EAST CLARK STREET",
            "city": "PINEWOOD",
            "state": "SC",
            "postal_code": "29125",
            "telephone_number": "803-774-4500",
            "fax_number": "803-452-5712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 EAST CLARK STREET",
            "city": "PINEWOOD",
            "state": "SC",
            "postal_code": "29125",
            "telephone_number": "803-774-4500",
            "fax_number": "803-452-5712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZELLE",
        "first_name": "DONNA",
        "middle_name": "GRIMSLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200300669",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "22449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89135JN",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L36646",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ark Transportation & Tours LLC.
• Robert Noyes Etheridge, M.D.
• Helene Guess-Goldsmith
• Kayla Lanay Jennings
• Sayward Oltman, NP
• Christine Smoak
• Tandem Health SC
• Tandem Health SC (Sumter Family Health Center - Pinewood)
• Laura Annette Weir

• Family Medicine Physician in Pinewood, SC
• Providers in Pinewood, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.
• 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.