NPIMap

Organization Active NPI

Community Wellness Group LLC

  • Internal Medicine Physician
  • Columbia, SC
National Provider Identifier
1982144606
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
COMMUNITY WELLNESS GROUP LLC
Practice address
2430 Atlas Rd Ste 1
Columbia, SC 29209-3625
Phone
(803) 586-1752
Fax
(877) 995-5934
NPI assigned
Feb 28, 2017
Last updated
Dec 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2021

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

Authorized official

Name
Mr. Kenneth Allan Simmons Sr.NPI 1972823250
Title
Director/Manager
Phone
(803) 586-1752

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 9

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X
Psychologist 103T00000X
Chiropractor 111N00000X
Internal Medicine Physician 207R00000X Primary
Cardiovascular Disease Physician 207RC0000X
Psychiatry Physician 2084P0800X
Addiction Medicine (Preventive Medicine) Physician 2083A0300X

Addresses

Primary practice location

2430 Atlas Rd Ste 1
Columbia, SC 29209-3625

Mailing address

7356 Garners Ferry Rd Suite 130
Columbia, SC 29209-2178
Phone (803) 586-1752

Other identifiers 1

IdentifierTypeStateIssuer
GP8968MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181005002437 SC Part B Supplier - Clinic/Group Practice 9234481060 Receives reassigned benefits from 4 practitioners
Practice locations: Columbia, SC; Union, SC

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
42D2160344Community Wellness Group2430 Atlas Rd, Columbia, SC 29209Certificate of waiverAug 29, 2027

National Provider Directory

National Provider Directory

Locations

2441 Atlas Rd
Ste 1
Columbia, SC 29209
Phone (803) 570-2522

2441 Atlas Rd
Ste I
Columbia, SC 29209
Phone (803) 570-2522

408 N Duncan Byp
Ste 12
Union, SC 29379
Phone (803) 570-2522

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1982144606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7356 GARNERS FERRY RD SUITE 130",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292092178",
            "telephone_number": "803-586-1752",
            "fax_number": "877-995-5934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 ATLAS RD STE 1",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292093625",
            "telephone_number": "803-586-1752",
            "fax_number": "877-995-5934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY WELLNESS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-28",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "DIRECTOR/MANAGER",
        "authorized_official_telephone_number": "803-586-1752",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8968",
            "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 Dec 7, 2021; 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.