Lake Marion Primary Care

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

20345 Issued in SC

Legal business name

LAKE MARION PRIMARY CARE

Practice address

15 E Hospital St
Manning, SC 29102-3152

Phone

(803) 435-2529

Fax

(803) 435-4196

NPI assigned

Apr 27, 2006

Organization subpart

No

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

Authorized official

Name

Saundra Wallace

Title

Administrator

Phone

(803) 435-2529

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 4

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

• Edward C. Keith Jr., MD

  • Family Medicine Physician
  • Columbia, SC
  • NPI 1003878455
  NPD (past)
• Ramon Proctan Sy, MD

  • Cardiovascular Disease Physician
  • Manning, SC
  • NPI 1457319535
  NPD (past)
• Donatus M. Egbonim, MD

  • Internal Medicine Physician
  • Farmington, NM
  • NPI 1962440875
  NPD (past)
• Issa Yusuf, MD

  • Internal Medicine Physician
  • Mitchellville, MD
  • NPI 1912934571
  NPD (past)

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1912964479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023152",
            "telephone_number": "803-435-2529",
            "fax_number": "803-435-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023152",
            "telephone_number": "803-435-2529",
            "fax_number": "803-435-4196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARION PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SAUNDRA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-435-2529"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "13275",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SC",
            "license": "20345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2178",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael S Kitchen, MD
• Thomas Lester Klvana, PA
• Peggy Knox
• Kelly Ann Koenig
• Mithun Reddy Kes Kumbharanahalli
• Lakeside Orthopaedic Center, LLC
• Lakeview Physical Therapy, LLC
• Ray Allen Langston, D.M.D.
• Tracy D Lanners, LCSW
• Melonie Dennis Layton, M.A. SLP, CCC

• Cardiovascular Disease Physician in Manning, SC
• Providers in Manning, SC by specialty
• Cardiovascular Disease Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.