NPIMap

Individual provider Active NPI

Martin C Mirra, MD

  • Surgery Physician
  • Columbia, SC
National Provider Identifier
1972615631
Registry record updated May 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
19670 Issued in SC
Practice address
1333 Taylor Street
Ste 3a
Columbia, SC 29201
Phone
(803) 254-4707
Fax
(803) 254-1198
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 19670 SC Primary

Addresses

Primary practice location

1333 Taylor Street
Ste 3a
Columbia, SC 29201

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
196709MedicaidSC

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
I20111028000244 SC Practitioner - General Surgery 0446423958 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of North Carolina at Chapel Hill School of Medicine, 1996
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)

1333 Taylor St
Suite 3a
Columbia, SC 29201-2947
Phone (803) 254-4707

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)17
Mastectomy1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19670SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Aug 13, 2016 Accepting new patients
Prisma Health Medical Group-Midlands Surgery CurrentSince Aug 13, 2016 Accepting new patients
Prisma Health-Midlands Current Accepting new patients
Prisma Health-Midlands CurrentSince Mar 10, 2014 Accepting new patients

Locations

1850 Laurel St
Columbia, SC 29201
Phone (803) 256-3400

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

400 Palmetto Health Pkwy
Columbia, SC 29212
Phone (803) 296-5579

1333 Taylor St
Ste 3A
Columbia, SC 29201
Phone (803) 254-4707

Interoperability endpoints

  • Direct secure messaging: mmirra382390@direct.ghs.myhfn.org

Organizations & group practices 4

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526601600000",
    "number": "1972615631",
    "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 STREET",
            "address_2": "STE 3A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29201",
            "telephone_number": "803-254-4707",
            "fax_number": "803-254-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRRA",
        "first_name": "MARTIN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "19670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196709",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.