NPIMap

Individual provider Active NPI

Cecelia Fogle Hall

  • Gerontology Nurse Practitioner
  • Columbia, SC
National Provider Identifier
1912487422
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
21544 Issued in SC
Practice address
1333 Taylor St Ste 5F
Columbia, SC 29201-2951
Phone
(803) 434-4790
Fax
(803) 434-4799
NPI assigned
Aug 15, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 21544 SC
Primary Care Nurse Practitioner 363LP2300X 21544 SC
Gerontology Nurse Practitioner 363LG0600X 21544 SC Primary

Addresses

Primary practice location

1333 Taylor St Ste 5F
Columbia, SC 29201-2951

Mailing address

PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320

Other identifiers 1

IdentifierTypeStateIssuer
NP5510MedicaidSC

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
I20181120002052 SC Practitioner - Nurse Practitioner 1254685753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

3 Richland Medical Park Dr
Suite 330
Columbia, SC 29203-6862
Phone (803) 434-4790

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
21544SCMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands Urology CurrentSince Nov 19, 2018 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Nov 19, 2018 Accepting new patients

Locations

3 Richland Medical Park Dr
Ste 330
Columbia, SC 29203
Phone (803) 434-7100

1333 Taylor St
Ste 5F
Columbia, SC 29201
Phone (803) 733-9598

3555 Harden Street Ext
Ste 300
Columbia, SC 29203
Phone (803) 434-6411

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

1301 Taylor St
Ste 1A
Columbia, SC 29201
Phone (803) 254-4591

Interoperability endpoints

  • Direct secure messaging: chall380539@direct.ghs.myhfn.org

Organizations & group practices 2

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 10

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": "1534291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1912487422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904",
            "telephone_number": "803-296-7320",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 TAYLOR ST STE 5F",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012951",
            "telephone_number": "803-434-4790",
            "fax_number": "803-434-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "CECELIA",
        "middle_name": "FOGLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-15",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SC",
            "license": "21544",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "SC",
            "license": "21544",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "SC",
            "license": "21544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP5510",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.