Community Wellness Group LLC
Organization Active NPI Internal Medicine Physician · Columbia, SC
NPI 1982144606 · NPPES record last updated Dec 7, 2021
Key facts
- NPI
- 1982144606
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Kenneth Allan Simmons Sr.
- Title
- Director/Manager
- Phone
- (803) 586-1752
Practitioners 13
-
Jason K Barber, M.D.
-
Francis Dowdy Gill, FNP-BC
-
Hope Ballard Hopkins, FNP-C
-
Lashundrea Oliver, PMHNP-BC
-
Kenneth A Simmons, LMSW
-
Askia Davis, F.N.P.
-
Alan N. Abel, M.D.
-
Sherri Cassidy, NURSE PRACTITIONER
-
Jody D Ellison, MD
-
Charmaine M George, M.D
-
Jada C Quinn, DNP
-
Walter E Smith, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D2160344 | Community Wellness Group | Certificate of waiver | Aug 29, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181005002437 | SC | Part B Supplier - Clinic/Group Practice | 9234481060 |
Receives reassigned benefits from 4 practitioners Practice locations: Columbia, SC; Union, SC |
National Provider Directory
Locations
2441 Atlas Rd
Ste I
Columbia, SC 29209
Phone (803) 570-2522
7358 Garners Ferry Rd
Ste 130
Columbia, SC 29209
Phone (478) 284-8688
2441 Atlas Rd
Ste 1
Columbia, SC 29209
Phone (803) 570-2522
7358 Garners Ferry Rd
Ste 125
Columbia, SC 29209
Phone (803) 834-5572
408 N Duncan Byp
Ste 12
Union, SC 29379
Phone (803) 570-2522
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Mental Health Counselor |
101YM0800X | |||
| Professional Counselor |
101YP2500X | |||
| Psychologist |
103T00000X | |||
| Chiropractor |
111N00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| Cardiovascular Disease Physician |
207RC0000X | |||
| Addiction Medicine (Preventive Medicine) Physician |
2083A0300X | |||
| Psychiatry Physician |
2084P0800X |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP8968 | Medicaid | SC |
Other providers in Columbia, SC
- Community Options, Inc.
- Community Pastor Care LLC
- Community Resource Solutions SC
- Community Resource Solutions, LLC - SC Columbia
- Community Resource Solutions, LLC - SC Columbia
- Companion Benefit Alternatives
- Companion Benefit Alternatives
- Companion Benefit Alternatives
- Companion Benefit Alternatives
- Compassionate Acceptance for Life,LLC
All providers in Columbia, SC · Internal Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.