NPIMap

Organization Active NPI

Edisto Regional Health Services

Doing business as St Matthews Family Practice

  • Family Medicine Physician
  • St Matthews, SC
National Provider Identifier
1942430871
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EDISTO REGIONAL HEALTH SERVICES
Doing business as
St Matthews Family Practice
Practice address
725 Harry C Raysor Dr
St Matthews, SC 29135-8403
Phone
(803) 874-3902
Fax
(803) 874-3905
NPI assigned
Jul 27, 2009
Last updated
Jan 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Authorized official

Name
Lisa M Goodlett
Title
C.O.O.
Phone
(803) 395-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

725 Harry C Raysor Dr
St Matthews, SC 29135-8403

Mailing address

PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4497

Other names 1

  • St Matthews Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810000307 SC Part B Supplier - Clinic/Group Practice 4981693447 Receives reassigned benefits from 41 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowman, SC; Bamberg, SC; Santee, SC; Saint Matthews, SC; Orangeburg, SC; Holly Hill, SC; Branchville, SC

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1942430871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161245",
            "telephone_number": "803-395-4497",
            "fax_number": "803-536-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 HARRY C RAYSOR DR",
            "city": "ST MATTHEWS",
            "state": "SC",
            "postal_code": "291358403",
            "telephone_number": "803-874-3902",
            "fax_number": "803-874-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO REGIONAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-27",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "GOODLETT",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "803-395-2200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Matthews Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Matthews, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.