NPIMap

Organization Active NPI

Palmetto Endoscopy Suite, LLC

  • Ambulatory Surgical Clinic/Center
  • Columbia, SC
National Provider Identifier
1972808186
Registry record updated Jan 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PALMETTO ENDOSCOPY SUITE, LLC
Practice address
1520 Taylor St
Columbia, SC 29201-2919
Phone
(803) 509-5710
Fax
(803) 509-5711
NPI assigned
Jan 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2012

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

Authorized official

Name
Dr. George Jenkins III, MDNPI 1932167087
Title
Doctor
Phone
(803) 509-5710

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

1520 Taylor St
Columbia, SC 29201-2919

Mailing address

1520 Taylor St
Columbia, SC 29201-2919
Phone (803) 509-5710

Other identifiers 1

IdentifierTypeStateIssuer
GP0932MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120208000846 SC Part B Supplier - Ambulatory Surgical Center 0244497865 Receives reassigned benefits from 1 practitioner
Practice locations: Columbia, SC

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Palmetto Endoscopy Suite LLCCCN 42C0001081
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2024647Palmetto Endoscopy Suite, LLC1520 Taylor Street, Suite 250, Columbia, SC 29201Certificate of waiverMay 19, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327968000000",
    "number": "1972808186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 TAYLOR ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012919",
            "telephone_number": "803-509-5710",
            "fax_number": "803-509-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 TAYLOR ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012919",
            "telephone_number": "803-509-5710",
            "fax_number": "803-509-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO ENDOSCOPY SUITE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2012-01-31",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "803-509-5710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0932",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.