NPIMap

Individual provider Active NPI

Manuel Antonio Fonseca, DO

  • Family Medicine Physician
  • Florence, SC
National Provider Identifier
1790769396
Registry record updated Jan 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0419 Issued in SC
Practice address
1925 Hoffmeyer Rd
Florence, SC 29501-4011
Phone
(843) 679-4214
Fax
(843) 674-5146
NPI assigned
Dec 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2025

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 0419 SC Primary

Addresses

Primary practice location

1925 Hoffmeyer Rd
Florence, SC 29501-4011

Mailing address

PO Box 23321
New York, NY 10087-3321
Phone (843) 679-4214

Other identifiers 1

IdentifierTypeStateIssuer
004195MedicaidSC

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
I20060404000631 SC Practitioner - Emergency MedicinePractitioner - Family Practice 8123036027 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

805 Pamplico Hwy
Florence, SC 29505-6047
Phone (843) 674-2500

Hospital & facility affiliations

  • Musc Health at Home by Bayada-Conway Home health agency, Conway, SC, CCN 427135
  • Musc Health Florence Medical Center Hospital, Florence, SC, CCN 420091
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • McLeod Regional Medical Center-Pee Dee Hospital, Florence, SC, CCN 420051

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0419SCMDFamily Medicine Physician
419SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians Family Medicine CurrentSince Jan 30, 2022 Accepting new patients
Musc Community Physicians Emergency Medicine Current Accepting new patients
Musc Community Physicians CurrentSince Jan 30, 2022 Accepting new patients
Carolina Family Care, Inc Family Medicine CurrentSince Jan 14, 2021 Accepting new patients
Carolina Family Care, Inc Family Medicine CurrentSince Jan 14, 2021 Accepting new patients
Spartanburg Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Marion Physician Services LLC Family Medicine Past Accepting new patients
QHG of South Carolina Inc Past Accepting new patients
Chesterfield-Marlboro LP Emergency Medicine Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1925 Hoffmeyer Rd
Florence, SC 29501
Phone (843) 661-4390

805 Pamplico Hwy
Ste Cma
Florence, SC 29505
Phone (843) 647-5143

805 Pamplico Hwy
Florence, SC 29505
Phone (843) 674-2500

1341 Old Georgetown Rd
Ste C
Mt Pleasant, SC 29464
Phone (843) 884-2175

2845 E Highway 76
Ste 3
Mullins, SC 29574
Phone (843) 431-2730

Interoperability endpoints

  • Direct secure messaging: mfonseca260027@direct.musc.edu

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1790769396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23321",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873321",
            "telephone_number": "843-679-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 HOFFMEYER RD",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295014011",
            "telephone_number": "843-679-4214",
            "fax_number": "843-674-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONSECA",
        "first_name": "MANUEL",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "0419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004195",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.