SOUTHERN ORTHOPAEDIC SPORTS MEDICNE (NPI# 1013965789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013965789 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ORTHOPAEDIC SPORTS MEDICNE |
| Practice Address |
1718 Saint Julian Pl Columbia SC 29204-2410 |
| Practice Telephone | 8033768880 |
| Practice Fax Number | 8033768881 |
| Mailing Telephone | 8033768880 |
| Mailing Fax Number | 8033768881 |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-10-24 |
| Authorized Official Name | EVAN FRANKLIN EKMAN (PRESIDENT) |
| Authorized Official Telephone | 8033768880 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
19175 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP2755 | 05 |
| Street Address |
1718 SAINT JULIAN PL |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-2410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609368356 | Matthew Garrett Ulcak | Physical Therapist | 1718 Saint Julian Pl, Columbia, SC 29204-2410 | 2018-05-30 |
| 1770785503 | John Eric Ashton | Physician Assistant | 1718 Saint Julian Pl, Columbia, SC 29204-2410 | 2007-06-04 |
| 1043421241 | Oakley Baumgardner Smyth | Physical Therapist | 1718 Saint Julian Pl, Columbia, SC 29204-2410 | 2007-05-28 |
| 1225050271 | Southern Orthopaedic Physical Therapy,llc | Physical Medicine & Rehabilitation | 1718 Saint Julian Pl, Columbia, SC 29204-2410 | 2006-07-25 |
| 1265454219 | Cynthia J Ekman | Physical Medicine & Rehabilitation | 1718 Saint Julian Pl, Columbia, SC 29204-2410 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992215149 | Ricardo Colon II | Registered Nurse | 3000 Hampton Street, Columbia, SC 29204 | 2017-10-02 |
| 1780113522 | Carla Star Noe | Registered Nurse | Sc Department of Health and Environmental Control, 2100 Bull Street, Collumbia, SC 29204 | 2017-06-06 |
| 1124568514 | Kristy L Thompson | Nurse Practitioner | 1655 Bernardin Ave Ste 240, Columbia, SC 29204 | 2017-03-03 |
| 1982052031 | Harold Eugene Cook Iv | Podiatrist | 1730 St Julian Place, Columbia, SC 29204 | 2016-05-31 |
| 1851748974 | Shaquita Banks | Counselor | 1810 Allen Benedict Ct, A1, Columbia, SC 29204 | 2016-05-18 |
| 1265804835 | Premier Care, LLC | Case Management | 2712 Middleburg Drive, Suite 206, Columbia, SC 29204 | 2015-10-22 |
| 1023492287 | Shamiquia N. Mcpherson | Counselor | 1627 Auburn St., Columbia, SC 29204 | 2015-07-16 |
| 1285028449 | The Columbia Free Medical Clinic, Inc. | Clinic/Center | 1875 Harden Street, Columbia, SC 29204 | 2015-03-26 |
| 1629473459 | Leslie Wilson | Counselor | 2323 Lady Street, Columbia, SC 29204 | 2014-10-22 |
| 1053728683 | Candyce Sutton | Social Worker | 1135 Carter Street, Columbia, SC 29204 | 2014-07-15 |
| Find all providers in zip 29204 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932369030 | Guillaume David Dumont | Orthopaedic Surgery | 2 Medical Park Road, Suite 104, Columbia, SC 29203-6875 | 2008-06-11 |
| 1770583817 | Robert Mario Dasilva | Orthopaedic Surgery | 1910 Blanding St, Columbia, SC 29201-3520 | 2005-07-29 |
| 1992227946 | Prisma Health Medical Group-midlands | Orthopaedic Surgery | 2 Medical Park Rd Ste 104, Columbia, SC 29203-6839 | 2017-07-12 |
| 1487107736 | Betina Hinckel | Orthopaedic Surgery | 1100 Virginia Ave Rm 4056, Columbia, MO 65212-0001 | 2016-08-03 |
| 1497198139 | Shawn Sahota | Orthopaedic Surgery | 1 S Keene St, Columbia, MO 65201-7199 | 2013-04-11 |
| 1942541610 | Bluetail Medical Group, LLC. | Orthopaedic Surgery | 1410 Forum Katy Pkwy, Ste. 100, Columbia, MO 65203-6325 | 2013-03-06 |
| 1972809192 | Mickey F Plymale | Orthopaedic Surgery | 14 Richland Medical Park Dr, Suite 200, Columbia, SC 29203-6877 | 2011-02-04 |
| 1699900084 | Tameem Mahmoud Yehyawi | Orthopaedic Surgery | 1 S Keene St, Columbia, MO 65201-7199 | 2009-05-28 |
| 1982844783 | Bradley Aspey | Orthopaedic Surgery | 1910 Blanding St, Columbia, SC 29201-3520 | 2009-03-06 |
| 1033187984 | Silas Wendell Holmes II | Orthopaedic Surgery | 14 Richland Medical Park Dr, Suite 200, Columbia, SC 29203-6877 | 2006-03-08 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.