Colonial Family Practice, LLC
Organization Active NPI Sports Medicine (Family Medicine) Physician · Sumter, SC
NPI 1831435429 · NPPES record last updated Oct 10, 2025
Key facts
- NPI
- 1831435429
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- Legal business name
- COLONIAL FAMILY PRACTICE, LLC
- Practice address
- 325 Broad St Ste 200
Sumter, SC 29150-4167 - Phone
- (803) 773-5227
- Fax
- (803) 418-0202
- NPI assigned
- Dec 31, 2012
- Organization subpart
- No
Authorized official
- Name
- Joy Kimball
- Title
- Contract Manager
- Phone
- (803) 256-1511
Other NPIs on the same Medicare enrollment 13
Practitioners 83
-
Arika Y Bryant, PA-C
-
Carrie Anne Judy, M.D.
-
John Kenneth Baker, M.D.
-
Amber Nicole Ballentine, APRN
-
Dale Scurry Barwick, ANP
-
Cody Becksvoort, D.O
-
Steven Jon Bosc II, PA-C
-
Angel Jeanine Brown, APRN
-
William Byrd, NP
-
Sherica Lynn Warfield Cain, FNP-C
-
Honey Dawn Chapman, DNP, APRN, FNP-C
-
Jaiwoo Chung, MD
-
Grace Wielicki Couch, FNP-C
-
Mary Kathleen Cox, FNP-C
-
Carmen Leticia Dominguez, M.D.
-
Barbara Jean Epps, FNP
-
Joselyn Elise Fair, FNP
-
Wanda Kay Fulton, FNP-BC
-
Mitchell Robert Grunsky, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040727000107 | SC | Part B Supplier - Clinic/Group Practice | 9931017118 |
Receives reassigned benefits from 88 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sumter, SC; Camden, SC; Manning, SC; Columbia, SC |
National Provider Directory
Locations
1013 Professional Ct
Ste C
Manning, SC 29102
Phone (803) 433-7425
327 Broad St
Sumter, SC 29150
Phone (803) 774-2781
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician |
207LP2900X | |||
| Family Medicine Physician |
207Q00000X | |||
| Sports Medicine (Family Medicine) Physician |
207QS0010X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
325 Broad St Ste 200
Sumter, SC 29150-4167
Mailing address
674 W Liberty St
Sumter, SC 29150-4882
Phone (803) 773-5227
Other names
- Colonial Pain Management
- Colonial Sports Medicine, Joint, & Arthritis Clinic
Other providers in Sumter, SC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Colonial Family Practice, LLC
- Columbia Vamc
- Nomigly Comeau
- Communities Developing Love and Care, LLC
All providers in Sumter, SC · Sports Medicine (Family Medicine) Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.