NPIMap

Individual provider Active NPI

Jennifer Funderburk Small, FNP-C

  • Family Nurse Practitioner
  • Indian Land, SC
National Provider Identifier
1932954286
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
28483 Issued in SC
Practice address
2021 Bridgemill Dr
Indian Land, SC 29707-9210
Phone
(803) 416-5410
NPI assigned
Apr 20, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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 28483 SC Primary

Addresses

Primary practice location

2021 Bridgemill Dr
Indian Land, SC 29707-9210

Mailing address

PO Box 23321
New York, NY 10087-4321
Phone (843) 876-1344

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Health Information Exchange (HIE)

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
I20240520000186 SC Practitioner - Nurse Practitioner 8921449190 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

2021 Bridgemill Dr
Indian Land, SC 29707-9210
Phone (803) 416-5410

838 W Meeting St
Suite a
Lancaster, SC 29720-6233
Phone (803) 286-1774

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Jun 1, 2024 Accepting new patients
Musc Community Physicians CurrentSince Jun 1, 2024 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients
Medical University Hospital Authority Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

2021 Bridgemill Dr
Indian Land, SC 29707
Phone (313) 509-7699

6277 Carolina Commons Dr
Ste 900
Indian Land, SC 29707
Phone (803) 431-7478

Interoperability endpoints

  • Direct secure messaging: jsmall253125@direct.musc.edu

Organizations & group practices 5

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 6

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": "1713571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1932954286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23321",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100874321",
            "telephone_number": "843-876-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 BRIDGEMILL DR",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297079210",
            "telephone_number": "803-416-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALL",
        "first_name": "JENNIFER",
        "middle_name": "FUNDERBURK",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-20",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "28483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2021 Bridgemill Dr",
            "city": "Indian Land",
            "state": "SC",
            "country_code": "US",
            "postal_code": "297079210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indian Land, SC

Sources for this page

Verify at the official NPI Registry.