NPIMap

Organization Active NPI

Three Rivers Medical Associates, PA

  • Internal Medicine Physician
  • Irmo, SC
National Provider Identifier
1760445597
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
THREE RIVERS MEDICAL ASSOCIATES, PA
Practice address
7430 College St
Irmo, SC 29063-2903
Phone
(839) 200-7510
Fax
(803) 891-7085
NPI assigned
Apr 11, 2006
Last updated
Jan 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Dr. John Gould III, DONPI 1215922091
Title
President
Phone
(839) 200-7510

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

7430 College St
Irmo, SC 29063-2903

Mailing address

7430 College St
Irmo, SC 29063-2903
Phone (839) 200-7510

Other identifiers 2

IdentifierTypeStateIssuer
GP1314MedicaidSC
CB9366OtherSCRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031210000142 SC Part B Supplier - Clinic/Group Practice 1557267663 Receives reassigned benefits from 19 practitioners
4 other NPIs on this enrollment
Practice locations: Columbia, SC; Irmo, SC

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
42D2253476Three Rivers Medical Associates7430 College Street, Irmo, SC 29063AccreditationMar 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Three Rivers Medical Associates PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1931 Bull St
Ste C
Columbia, SC 29201
Phone (839) 200-7822

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1760445597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7430 COLLEGE ST",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632903",
            "telephone_number": "839-200-7510",
            "fax_number": "803-891-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7430 COLLEGE ST",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632903",
            "telephone_number": "839-200-7510",
            "fax_number": "803-891-7085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "GOULD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "839-200-7510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1314",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB9366",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irmo, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.