NPIMap

Individual provider Active NPI

Alan John Enjetti, M.D.

  • Emergency Medicine Physician
  • Columbia, SC
National Provider Identifier
1992155501
Registry record updated Apr 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
LL39618 Issued in SC
Practice address
14 Medical Park Ste 350
Emergency Medicine Department
Columbia, SC 29203
Phone
(803) 434-3790
Fax
(803) 434-3946
NPI assigned
Jun 14, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X LL39618 SC Primary

Addresses

Primary practice location

14 Medical Park Ste 350
Emergency Medicine Department
Columbia, SC 29203

Mailing address

14 Medical Park Ste 350
Emergency Medicine Department
Columbia, SC 29203
Phone (803) 434-3790

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190128001620 SC Practitioner - Emergency Medicine 0345587416 Reassigns benefits to 1 organization
I20190920000635 VA Practitioner - Emergency Medicine 0345587416 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
JC Edwards School of Medicine, Marshall University, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Physicians of TidewaterGroup PAC ID 5092618462, 167 clinicians

Practice addresses (Care Compare)

3920 Bridge Rd
Suffolk, VA 23435-1107
Phone (757) 686-3508

830 Kempsville Rd
Norfolk, VA 23502-3920
Phone (757) 261-4325

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL39618SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Physicians of Tidewater CurrentSince Aug 1, 2022 Accepting new patients
Emergency Physicians of Tidewater Emergency Medicine CurrentSince Aug 1, 2019 Accepting new patients
McLeod Health Cheraw CurrentSince Nov 14, 2018 Accepting new patients
McLeod Health Cheraw Emergency Medicine CurrentSince Nov 14, 2018 Accepting new patients
Hyperbaric Physician Services LLC CurrentSince Jul 9, 2025 Accepting new patients
Hyperbaric Physician Services LLC Current Accepting new patients

Locations

711 Chesterfield Hwy
Cheraw, SC 29520
Phone (843) 320-3304

11803 Jefferson Ave
#120
Newport News, VA 23606
Phone (757) 594-1060

830 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-6000

2800 Godwin Blvd
Suffolk, VA 23434
Phone (757) 363-6850

3920 Bridge Rd
Suffolk, VA 23435
Phone (757) 668-4114

800 Independence Blvd
Virginia Beach, VA 23455
Phone (757) 363-6100

Organizations & group practices 6

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 5

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": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681689600000",
    "number": "1992155501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MEDICAL PARK STE 350",
            "address_2": "EMERGENCY MEDICINE DEPARTMENT",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-3790",
            "fax_number": "803-434-3946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MEDICAL PARK STE 350",
            "address_2": "EMERGENCY MEDICINE DEPARTMENT",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-3790",
            "fax_number": "803-434-3946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENJETTI",
        "first_name": "ALAN",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-14",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "LL39618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.