NPIMap

Individual provider Active NPI

Roxie Chisholm, FNP-C

  • Family Nurse Practitioner
  • Columbia, SC
National Provider Identifier
1932502572
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19084 Issued in SC
Practice address
115 Blarney Dr Ste 108
Columbia, SC 29223-6291
Phone
(803) 462-9200
Fax
(803) 699-1474
NPI assigned
Sep 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 19084 SC Primary

Addresses

Primary practice location

115 Blarney Dr Ste 108
Columbia, SC 29223-6291

Mailing address

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

Other practice location 1

4100 N Main St Ste 101
Columbia, SC 29203-5800
Phone (803) 754-0006

Other practice location 2

11 Atrium Ridge Ct
Columbia, SC 29223-6438
Phone (803) 699-9992

Other identifiers 1

IdentifierTypeStateIssuer
NP5000MedicaidSC

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
I20150128000906 SC Practitioner - Nurse Practitioner 3779807490 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
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)

115 Blarney Dr
Columbia, SC 29223-6291
Phone (803) 462-9200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19084SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Mar 26, 2018 Accepting new patients
Albert Humphrey CurrentSince Oct 2, 2014 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Mar 26, 2018 Accepting new patients

Locations

4100 N Main St
Ste 203
Columbia, SC 29203
Phone (803) 754-0006

11 Atrium Ridge Ct
Columbia, SC 29223
Phone (803) 205-0406

4100 N Main St
Ste 101
Columbia, SC 29203
Phone (803) 256-0101

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

Interoperability endpoints

  • Direct secure messaging: rchisholm378291@direct.ghs.myhfn.org

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 and National Provider Directory roles.

Hospital & facility affiliations 11

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": "1411689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1932502572",
    "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": "115 BLARNEY DR STE 108",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236291",
            "telephone_number": "803-462-9200",
            "fax_number": "803-699-1474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 N Main St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292035800",
            "country_code": "US",
            "telephone_number": "803-754-0006",
            "fax_number": "803-735-1635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11 Atrium Ridge Ct",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292236438",
            "country_code": "US",
            "telephone_number": "803-699-9992",
            "fax_number": "803-865-7429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHISHOLM",
        "first_name": "ROXIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-26",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP5000",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.