Individual provider Active NPI

Heather C. Mathis, PA

  • Physician Assistant
  • Aiken, SC
National Provider Identifier
1790862415
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
A850 Issued in SC
Practice address
6167 Braided Mane Pass SW
Aiken, SC 29803-7839
Phone
(803) 648-1464
Fax
(803) 649-2027
NPI assigned
Nov 1, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X A850 SC Primary

Addresses

Primary practice location

6167 Braided Mane Pass SW
Aiken, SC 29803-7839

Mailing address

PO Box 485
Columbia, SC 29202-0485
Phone (803) 898-8405

Other practice location 1

220 Faison Dr
Columbia, SC 29203-3210
Phone (803) 898-8405

Other identifiers 1

IdentifierTypeStateIssuer
0293PAMedicaidSC

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
I20050901000556 SC Practitioner - Physician Assistant 8921030792 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Urgent Cares LLCGroup PAC ID 8628502598, 183 clinicians

Practice addresses (Care Compare)

6167 Braided Mane Pass SW
Aiken, SC 29803-7839
Phone (803) 648-1464

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
480SCMDSurgical Physician Assistant
850SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Doctors Care SC, PA Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1790862415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 485",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292020485",
            "telephone_number": "803-898-8405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6167 BRAIDED MANE PASS SW",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298037839",
            "telephone_number": "803-648-1464",
            "fax_number": "803-649-2027"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 Faison Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292033210",
            "country_code": "US",
            "telephone_number": "803-898-8405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "HEATHER",
        "middle_name": "C.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "A850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0293PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiken, SC

Sources for this page

Verify at the official NPI Registry.