NPIMap

Individual provider Active NPI

Carl B Shealy, MD

  • Nephrology Physician
  • Columbia, SC
National Provider Identifier
1861467235
Registry record updated Nov 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
23581 Issued in SC
Practice address
121 Park Central Dr
200
Columbia, SC 29203-6469
Phone
(803) 252-9907
Fax
(803) 252-9906
NPI assigned
Feb 21, 2006
Last updated
Nov 2, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 23581 SC Primary

Addresses

Primary practice location

121 Park Central Dr
200
Columbia, SC 29203-6469

Mailing address

121 Park Central Dr
200
Columbia, SC 29203-6469
Phone (803) 252-9907

Other identifiers 1

IdentifierTypeStateIssuer
235819MedicaidSC

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
I20100220000167 SC Practitioner - Nephrology 6507900115 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Medical University of South Carolina College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

121 Park Central Dr
Suite 200
Columbia, SC 29203-6476
Phone (803) 726-2399

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23581SCMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Nephrology Associates PA CurrentSince Jul 28, 2003 Accepting new patients
Columbia Nephrology Associates PA Nephrology CurrentSince Jul 28, 2003 Accepting new patients
Fresenius Medical Care Cna Kidney Centers, LLC PastSince Dec 21, 2008 Accepting new patients

Locations

121 Park Central Dr
Ste 200
Columbia, SC 29203
Phone (803) 252-9907

3630 Sunset Blvd
West Columbia, SC 29169
Phone (803) 779-1420

Interoperability endpoints

  • Direct secure messaging: cbrentshealy@cna.allscriptsdirect.net
  • Direct secure messaging: cshealy380630@direct.musc.edu

Organizations & group practices 3

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509580800000",
    "number": "1861467235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 PARK CENTRAL DR",
            "address_2": "200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036469",
            "telephone_number": "803-252-9907",
            "fax_number": "803-252-9906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 PARK CENTRAL DR",
            "address_2": "200",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036469",
            "telephone_number": "803-252-9907",
            "fax_number": "803-252-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEALY",
        "first_name": "CARL",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2017-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "SC",
            "license": "23581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235819",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.