NPIMap

Individual provider Active NPI

Kaoru Joan Pridgen, M.D.

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1790755353
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25856 Issued in SC
Practice address
1301 Taylor St Ste 5K
Columbia, SC 29201-2952
Phone
(839) 200-7805
Fax
(803) 891-7085
NPI assigned
Jan 25, 2006
Last updated
Jan 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25856 SC Primary

Addresses

Primary practice location

1301 Taylor St Ste 5K
Columbia, SC 29201-2952

Mailing address

7430 College St
Irmo, SC 29063-2903
Phone (839) 200-7810

Other practice location 1

7430 College St
Irmo, SC 29063-2903
Phone (839) 200-7810

Other identifiers 1

IdentifierTypeStateIssuer
258562MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060317000163 SC Practitioner - Family Practice 9032126990 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1301 Taylor St
Suite 5K
Columbia, SC 29201-2952
Phone (839) 200-7805

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Palmetto Primary Care Physicians, LLC Family Medicine Current Accepting new patients
Three Rivers Medical Associates, PA CurrentSince Dec 6, 2021 Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Three Rivers Medical Associates, PA Family Medicine CurrentSince Dec 6, 2021 Accepting new patients

Locations

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

114 Gateway Corporate Blvd
Ste 300
Columbia, SC 29203
Phone (803) 254-3278

115 Atrium Way
Ste 120
Columbia, SC 29223
Phone (803) 445-2941

1301 Taylor St
Ste 5K
Columbia, SC 29201
Phone (803) 765-2090

710 Rabon Rd
Ste 203
Columbia, SC 29203
Phone (803) 274-6166

7430 College St
Irmo, SC 29063
Phone (803) 732-4001

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

201 Sigma Dr
Ste 100
Summerville, SC 29486
Phone (843) 820-3397

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25140/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kauro.pridgen.1@25140.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1790755353",
    "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": "839-200-7810",
            "fax_number": "803-891-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 TAYLOR ST STE 5K",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012952",
            "telephone_number": "839-200-7805",
            "fax_number": "803-891-7085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7430 College St",
            "address_purpose": "LOCATION",
            "city": "Irmo",
            "state": "SC",
            "postal_code": "290632903",
            "country_code": "US",
            "telephone_number": "839-200-7810",
            "fax_number": "803-891-7085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRIDGEN",
        "first_name": "KAORU",
        "middle_name": "JOAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "25856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "258562",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.