Individual provider Active NPI

Sarah Doctor-Greenwade

  • Internal Medicine Physician
  • Columbia, SC
National Provider Identifier
1801392634
Registry record updated Jan 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
823005560 Issued in SC
Practice address
140 Wildewood Park Dr Ste 105
Columbia, SC 29223-4312
Phone
(803) 451-0449
Fax
(803) 753-9568
NPI assigned
Apr 2, 2018
Last updated
Jan 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 823005560 SC Primary

Addresses

Primary practice location

140 Wildewood Park Dr Ste 105
Columbia, SC 29223-4312

Mailing address

PO Box 23328
Columbia, SC 29224-3328
Phone (803) 722-4988

Other identifiers 1

IdentifierTypeStateIssuer
GP8160MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Concierge Medical Lab Multi-Specialty CurrentSince Sep 24, 2023 Accepting new patients
Concierge Medical Group LLC Multi-Specialty CurrentSince Nov 1, 2017 Accepting new patients

Locations

140 Wildewood Park Dr
Ste 107
Columbia, SC 29223
Phone (803) 722-4988

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": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673827200000",
    "number": "1801392634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23328",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292243328",
            "telephone_number": "803-722-4988",
            "fax_number": "803-656-8135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 WILDEWOOD PARK DR STE 105",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292234312",
            "telephone_number": "803-451-0449",
            "fax_number": "803-753-9568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOCTOR-GREENWADE",
        "first_name": "SARAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "823005560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8160",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.