Individual provider Active NPI

Jody D Ellison, MD

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1891745980
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20390 Issued in SC
Practice address
4500 8TH Division Rd
Columbia, SC 29207-5700
Phone
(803) 751-2160
NPI assigned
May 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20390 SC Primary

Addresses

Primary practice location

4500 8TH Division Rd
Columbia, SC 29207-5700

Mailing address

4500 8TH Division Rd
Columbia, SC 29207-5700
Phone (803) 751-2160

Other identifiers 2

IdentifierTypeStateIssuer
FQC030MedicaidSC
FQC043MedicaidSC

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040707001208 SC Practitioner - Family Practice 1557349545 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Eau Claire Cooperative Health Center ,Inc. CurrentSince Mar 19, 2012 Accepting new patients
Eau Claire Cooperative Health Center, Inc. Family Medicine CurrentSince Mar 19, 2012 Accepting new patients
Community Wellness Group LLC PastSince Jul 27, 2018 Accepting new patients
Sivad Primary Care and Associates P.C. PastSince Aug 30, 2009 Accepting new patients

Locations

1228 Harden St
Columbia, SC 29204
Phone (803) 744-0540

1520 Laurel St
Columbia, SC 29201
Phone (803) 256-3400

4605 Monticello Rd
Columbia, SC 29203
Phone (803) 252-7001

9019 Garners Ferry Rd
Ste B
Hopkins, SC 29061
Phone (803) 695-8444

1136 Kincaid Bridge Rd
#A
Winnsboro, SC 29180
Phone (803) 635-1052

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1891745980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 8TH DIVISION RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292075700",
            "telephone_number": "803-751-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 8TH DIVISION RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292075700",
            "telephone_number": "803-751-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "JODY",
        "middle_name": "D",
        "name_prefix": "Miss",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "20390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC030",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC043",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.