Individual provider Active NPI

Ethan Smallwood, PA

  • Surgical Physician Assistant
  • West Columbia, SC
National Provider Identifier
1831899459
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
4903 Issued in SD
Practice address
222 E Medical LN Ste 101
West Columbia, SC 29169-4850
Phone
(803) 739-3660
NPI assigned
Mar 3, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 4903 SD Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

222 E Medical LN Ste 101
West Columbia, SC 29169-4850

Mailing address

222 E Medical LN Ste 101
West Columbia, SC 29169-4850

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address esmallwood161595@direct.lexmed.com

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
I20230623001799 SC Practitioner - Physician Assistant 1355709361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Carolina School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lexington Health IncGroup PAC ID 2567872070, 905 clinicians

Practice addresses (Care Compare)

222 E Medical LN
Suite 101
West Columbia, SC 29169-4850
Phone (803) 739-3660

2720 Sunset Blvd
West Columbia, SC 29169-4810
Phone (803) 791-2460

3016 Longtown Commons Dr
Columbia, SC 29229-7849

4080 Augusta Hwy
Gilbert, SC 29054-8893

5535 Platt Springs Rd
Lexington, SC 29073-7519
Phone (803) 314-9510

557 Columbia Ave
Chapin, SC 29036-8324

565 Columbia Ave
Chapin, SC 29036-8324

76 Polo Rd
Columbia, SC 29223-2806
Phone (803) 699-7255

811 W Main St
Lexington, SC 29072-2500

Hospital & facility affiliations

  • Lexington Medical Center Hospital, West Columbia, SC, CCN 420073

Merit-based Incentive Payment System (MIPS)

Final score
84.09 of 100Reported as group
Quality
68.87
Promoting interoperability
100
Improvement activities
40
Cost
78.11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4903SDMDPharmacist
4903SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Lexington Health Inc CurrentSince Jun 1, 2023 Accepting new patients
Lexington County Health Services District Inc Current Accepting new patients
Lexington Health Inc CurrentSince Jun 1, 2023 Accepting new patients
Lexington County Health Services District, Inc. Past Accepting new patients

Locations

3016 Longtown Commons Dr
Ste 205
Columbia, SC 29229
Phone (803) 739-3660

811 W Main St
Ste 101
Lexington, SC 29072
Phone (803) 936-7230

222 E Medical Ln
Ste 101
West Columbia, SC 29169
Phone (803) 739-3660

Interoperability endpoints

  • Direct secure messaging: esmallwood161595@direct.lexmed.com

Organizations & group practices 5

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 1

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": "1677801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1831899459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 E MEDICAL LN STE 101",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 E MEDICAL LN STE 101",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694850",
            "telephone_number": "803-739-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALLWOOD",
        "first_name": "ETHAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-03",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SD",
            "license": "4903",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "esmallwood161595@direct.lexmed.com",
            "affiliation": "N",
            "address_1": "222 E Medical Ln Ste 101",
            "city": "West Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291694850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Columbia, SC

Sources for this page

Verify at the official NPI Registry.