NPIMap

Organization Active NPI

Palmetto Ophthalmology Associates, P.a.

  • Ophthalmology Physician
  • Leesville, SC
National Provider Identifier
1992985071
Registry record updated Jun 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PALMETTO OPHTHALMOLOGY ASSOCIATES, P.A.
Practice address
121 Main St
Leesville, SC 29070-8016
Phone
(803) 532-3203
Fax
(803) 532-3386
NPI assigned
Nov 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2009

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

Authorized official

Name
Dr. Mark S. Keisler, M.D.NPI 1023159431
Title
Owner
Phone
(803) 359-8777

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
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

121 Main St
Leesville, SC 29070-8016

Mailing address

121 Main St
Leesville, SC 29070-8016
Phone (803) 532-3023

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051010000265 SC Part B Supplier - Clinic/Group Practice 8628973922 Receives reassigned benefits from 4 practitioners
Practice locations: Leesville, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

101 Oak Park Dr
Irmo, SC 29063
Phone (803) 781-7950

121 Main St
Leesville, SC 29070
Phone (803) 532-3202

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245369600000",
    "number": "1992985071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 MAIN ST",
            "city": "LEESVILLE",
            "state": "SC",
            "postal_code": "290708016",
            "telephone_number": "803-532-3023",
            "fax_number": "803-532-3386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 MAIN ST",
            "city": "LEESVILLE",
            "state": "SC",
            "postal_code": "290708016",
            "telephone_number": "803-532-3203",
            "fax_number": "803-532-3386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO OPHTHALMOLOGY ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2009-06-19",
        "status": "A",
        "authorized_official_last_name": "KEISLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-359-8777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.