Springdale Family Practice

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

SC9312 Issued in SC

Legal business name

SPRINGDALE FAMILY PRACTICE

Practice address

3316 Platt Springs Rd
West Columbia, SC 29170-2247

Phone

(803) 796-1522

Fax

(803) 794-7061

NPI assigned

Dec 5, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John Robert Dunn III, M.D.NPI 1962687384

Title

President

Phone

(803) 796-1521

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Robert Dunn III, M.D.

  • Family Medicine Physician
  • West Columbia, SC
  • NPI 1962687384

  SC, Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912065327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3316 PLATT SPRINGS RD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291702247",
            "telephone_number": "803-796-1522",
            "fax_number": "803-794-7061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3316 PLATT SPRINGS RD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291702247",
            "telephone_number": "803-796-1522",
            "fax_number": "803-794-7061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGDALE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-796-1521",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "SC",
            "license": "SC9312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPO325",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loretta B Spencer, MS
• Hailey Denise Spires, MS, RD, LD
• Michelle L Spittler, OD
• Daria Patres Spratley, MS, RD, LD
• Tayvia Spratt, CRNA
• Joanna Stafford
• Kara Nicole Stahl, OTR/L
• David J Stallard, MD
• Kendall Elizabeth Stalls, MD
• Melissa Ann Stancil, COTA/L

• All providers in West Columbia, SC
• Primary Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.