NPIMap

Individual provider Active NPI

Mark Edward Humphrey, MD

  • Family Medicine Physician
  • Winnsboro, SC
National Provider Identifier
1801976402
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36168 Issued in SC
Practice address
56 US Highway 321 Byp N
Winnsboro, SC 29180-7100
Phone
(803) 635-6343
Fax
(803) 635-6343
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X R1133 KY
Public Health & General Preventive Medicine Physician 2083P0901X 36168 SC
Family Medicine Physician 207Q00000X 36168 SC Primary

Addresses

Primary practice location

56 US Highway 321 Byp N
Winnsboro, SC 29180-7100

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

3209 Colonial Dr
University Specialty Clinics-Family & Preventive Medici
Columbia, SC 29203-6930
Phone (803) 434-6113

Other identifiers 1

IdentifierTypeStateIssuer
361682MedicaidSC

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
I20131030001039 SC Practitioner - Family PracticePractitioner - Preventive Medicine 9537260344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Preventive Medicine
Education
Wright State University Boonshoft School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

3209 Colonial Dr
Columbia, SC 29203-6930
Phone (803) 434-6113

Hospital & facility affiliations

  • Prisma Health Richland Hospital Hospital, Columbia, SC, CCN 420018
  • Prisma Health Baptist Hospital, Columbia, SC, CCN 420086

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Oct 28, 2016 Accepting new patients
Prisma Health Medical Group-Midlands Emergency Medicine CurrentSince Oct 28, 2016 Accepting new patients
Prisma Health-Midlands Past Accepting new patients
The Medical Center at Franklin ER Physicians Emergency Medicine Past Accepting new patients
Prisma Health-Midlands Past Accepting new patients
Jane Todd Crawford Memorial Hospital, Inc. Past Accepting new patients

Locations

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

3209 Colonial Dr
Columbia, SC 29203
Phone (803) 434-6113

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

56 US Highway 321 Byp N
Winnsboro, SC 29180
Phone (803) 635-6099

Interoperability endpoints

  • Direct secure messaging: mhumphrey380242@direct.ghs.myhfn.org

Organizations & group practices 6

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.

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1801976402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 US HIGHWAY 321 BYP N",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291807100",
            "telephone_number": "803-635-6343",
            "fax_number": "803-635-6343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3209 Colonial Dr",
            "address_2": "University Specialty Clinics-Family & Preventive Medici",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292036930",
            "country_code": "US",
            "telephone_number": "803-434-6113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUMPHREY",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "R1133",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "SC",
            "license": "36168",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "36168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "361682",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winnsboro, SC

Sources for this page

Verify at the official NPI Registry.