Individual provider Active NPI

Karen Fisher Mattocks, M.D.

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1982660148
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20030 Issued in SC
Practice address
3010 Farrow Rd
Suite 300
Columbia, SC 29203-7607
Phone
(803) 434-1210
Fax
(803) 434-1212
NPI assigned
Apr 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20030 SC Primary

Addresses

Primary practice location

3010 Farrow Rd
Suite 300
Columbia, SC 29203-7607

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
200302MedicaidSC

Other names 1

  • Miss Karen Deneen Fisher Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060726000322 SC Practitioner - Family Practice 7618980277 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20030SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Nov 26, 2016 Accepting new patients
Prisma Health Medical Group-Midlands Family Medicine CurrentSince Nov 26, 2016 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

3 Richland Medical Park Dr
Ste 510
Columbia, SC 29203
Phone (803) 296-2726

3010 Farrow Rd
Ste 300
Columbia, SC 29203
Phone (803) 434-1210

3555 Harden Street Ext
Ste 300
Columbia, SC 29203
Phone (803) 434-6411

9 Richland Medical Park Dr
Ste 230
Columbia, SC 29203
Phone (803) 434-1210

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560297600000",
    "number": "1982660148",
    "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": "3010 FARROW RD",
            "address_2": "SUITE 300",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292037607",
            "telephone_number": "803-434-1210",
            "fax_number": "803-434-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTOCKS",
        "first_name": "KAREN",
        "middle_name": "FISHER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2019-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "20030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200302",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAREN",
            "last_name": "FISHER",
            "middle_name": "DENEEN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.