Individual provider Active NPI

Emmeline Short

  • Family Nurse Practitioner
  • Columbia, SC
National Provider Identifier
1760868962
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19681 Issued in SC
Practice address
14 Richland Medical Park Dr Ste 320
Columbia, SC 29203-6896
Phone
(803) 434-6771
Fax
(803) 434-3955
NPI assigned
Aug 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 19681 SC Primary

Addresses

Primary practice location

14 Richland Medical Park Dr Ste 320
Columbia, SC 29203-6896

Mailing address

PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320

Other identifiers 1

IdentifierTypeStateIssuer
NP3376MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eshort384281@direct.ghs.myhfn.org Direct

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151027001613 SC Practitioner - Nurse Practitioner 6002125333 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
19681SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Apr 1, 2019 Accepting new patients
Eau Claire Cooperative Health Center, Inc. CurrentSince Aug 4, 2015 Accepting new patients
Eau Claire Cooperative Health Center ,Inc. CurrentSince Aug 4, 2015 Accepting new patients
Prisma Health Medical Group-Midlands Current Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Apr 1, 2019 Accepting new patients

Locations

Taylor At Marion St
Columbia, SC 29220
Phone (803) 296-3097

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

4605 Monticello Rd
Columbia, SC 29203
Phone (803) 252-7001

14 Richland Medical Park Dr
Ste 320
Columbia, SC 29203
Phone (803) 434-1663

9017 State Highway 215 S
Jenkinsville, SC 29065
Phone (803) 296-2068

Interoperability endpoints

  • Direct secure messaging: eshort384281@direct.ghs.myhfn.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1760868962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904",
            "telephone_number": "803-296-7320",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 RICHLAND MEDICAL PARK DR STE 320",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036896",
            "telephone_number": "803-434-6771",
            "fax_number": "803-434-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORT",
        "first_name": "EMMELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP3376",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eshort384281@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "eshort384281@direct.ghs.myhfn.org",
            "address_1": "14 Richland Medical Park Dr Ste 320",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292036896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.