PRISMA HEALTH MEDICAL GROUP-MIDLANDS (NPI# 1285678078) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285678078 |
| Entity Type | Organization |
| Organization Name | PRISMA HEALTH MEDICAL GROUP-MIDLANDS |
| Other Organization Name | PH MEDICAL GROUP MIDLANDS |
| Practice Address |
9 Richland Medical Park Dr Ste 410 Columbia SC 29203-6859 |
| Mailing Address |
Po Box 743904 Atlanta GA 30374-3904 |
| Practice Telephone | 8034347995 |
| Practice Fax Number | 8034347983 |
| Mailing Telephone | 8032967032 |
| Mailing Fax Number | 8032967330 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-09-11 |
| Authorized Official Name | JAMES ELLIS (CHIEF INTEGRATION OFFICER) |
| Authorized Official Telephone | 8035455048 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0208X |
Pediatrics Specialization: Pediatric Infectious Diseases |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | OPAC03 | 05 |
| Other Name | Type Code |
|---|---|
| PH Medical Group Midlands | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518455252 | Prisma Health Medical Group-midlands | Orthopaedic Surgery | 100 N Sumter St Ste 200, Sumter, SC 29150-4975 | 2018-04-27 |
| 1992226534 | Prisma Health Medical Group-midlands | Orthopaedic Surgery | 101 Business Park Blvd Fl 2, Columbia, SC 29203-8401 | 2017-07-05 |
| 1538680004 | Prisma Health Medical Group-midlands | Orthopaedic Surgery | 300 Palmetto Health Pkwy Ste 200, Columbia, SC 29212-1762 | 2017-07-05 |
| 1255852901 | Prisma Health Medical Group-midlands | Orthopaedic Surgery | 100 Palmetto Health Pkwy Ste 320, Columbia, SC 29212-1756 | 2017-07-03 |
| 1417442864 | Prisma Health Medical Group-midlands | Dentist | 10 Richland Medical Park Dr Ste A, Columbia, SC 29203-6892 | 2018-06-28 |
| 1003307166 | Prisma Health Medical Group-midlands | Internal Medicine | 8 Richland Medical Park Dr Ste 300, Columbia, SC 29203-8008 | 2018-05-24 |
| 1447749510 | Prisma Health Medical Group-midlands | Family Medicine | 115 N Sumter St Ste 115, Sumter, SC 29150 | 2018-05-04 |
| 1295222503 | Prisma Health Medical Group-midlands | Oral & Maxillofacial Surgery | 3304 Forest Dr, Columbia, SC 29204-4024 | 2018-04-23 |
| 1457848848 | Prisma Health Medical Group-midlands | Pediatrics | 9 Richland Medical Park Dr Ste 210, Columbia, SC 29203-6859 | 2018-04-20 |
| 1871080283 | Prisma Health Medical Group-midlands | Hospitalist | 115 N Sumter St Ste 400, Sumter, SC 29150-4971 | 2018-04-20 |
| Street Address |
9 RICHLAND MEDICAL PARK DR STE 410 |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29203-6859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104312867 | Angela Kokoska | Registered Nurse | 9 Richland Medical Park Dr Ste 410, Columbia, SC 29203-6859 | 2018-07-06 |
| 1083059232 | Jodi Dingle | Pediatrics | 9 Richland Medical Park Dr Ste 410, Columbia, SC 29203-6859 | 2013-05-01 |
| 1689702698 | Colleen Ann Wunderlich | Physical Medicine & Rehabilitation | 9 Richland Medical Park Dr Ste 410, Columbia, SC 29203-6859 | 2007-03-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475284 | Matthew Leon Brigmon | Surgery | 2 Richland Medical Park, Suite 300, Columbia, SC 29203 | 2020-10-23 |
| 1730706839 | John James Gannon | Family Medicine | Prisma Health Medical Group Family Medicine, 3209 Colonial Drive, Columbia, SC 29203 | 2020-07-06 |
| 1790302362 | Klariz Teves Tucker | Internal Medicine | Internal Medcine Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-30 |
| 1811514482 | Esther Ruth Swan | Psychiatry & Neurology | Prisma Health General Psychiatry Center, 15 Medical Park, Ste 141, Columbia, SC 29203 | 2020-06-30 |
| 1447877014 | Jordan Kaitlyn Merrels | Psychiatry & Neurology | Prisma Health Medical Group General Psychiatry, 15 Medical Park, Ste 141, Columbia, SC 29203 | 2020-06-30 |
| 1306463187 | Jessica Leigh Watson | Psychiatry & Neurology | Prisma Health General Psychiatry, 15 Medical Park, Ste 141, Columbia, SC 29203 | 2020-06-29 |
| 1053938852 | Garrison Glenn Rice | Family Medicine | Prisma Health Medical Group Family Medical Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-29 |
| 1053938977 | Rachel Ellen Harper | Obstetrics & Gynecology | The Womens Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-26 |
| 1609493592 | Elizabeth Marie Kern | Orthopaedic Surgery | Prisma Health Medical Group Orthopedic Center, 2 Medical Park, Ste 105, Columbia, SC 29203 | 2020-06-26 |
| 1891312799 | Kathryn Victoria Steverson | Psychiatry & Neurology | Prisma Health Medical Group Psychiatry Center, 15 Medical Park, Ste 141, Columbia, SC 29203 | 2020-06-26 |
| Find all providers in zip 29203 | ||||
| Taxonomy Code | 2080P0208X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Infectious Diseases |
| A pediatrician trained to care for children in the diagnosis, treatment and prevention of infectious diseases. This specialist can apply specific knowledge to affect a better outcome for pediatric infections with complicated courses, underlying diseases that predispose to unusual or severe infections, unclear diagnoses, uncommon diseases and complex or investigational treatments. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932698511 | Palmetto Health - University of South Carolina Medical Group | Pediatrics | 9 Richland Medical Park Dr Ste 210, Columbia, SC 29203-6859 | 2018-05-09 |
| 1083849871 | Christelle Marlyse Ilboudo | Pediatrics | 404 N Keene St, Columbia, MO 65201-6626 | 2009-05-21 |
| 1194761577 | George Stephen Kotchmar Jr. | Pediatrics | 9 Medical Park Rd, Suite 210, Columbia, SC 29203-6873 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497163547 | Marie Jose Moubarak | Pediatrics | 407 N Brown St, West Columbia, SC 29169 | 2014-07-31 |
| 1013244714 | Ghs Partners In Health, Inc. | Pediatrics | 200 Patewood Dr, Suite A200, Greenville, SC 29615-3593 | 2009-11-17 |
| 1134372089 | University Medical Associates | Pediatrics | 171 Ashley Ave, Charleston, SC 29425-8908 | 2008-10-23 |
| 1427223429 | Terry Carlyle Dixon | Pediatrics | 96 Jonathan Lucas St, Division of Pediatric Infectious Diseases Musc, Charleston, SC 29425-8900 | 2008-04-29 |
| 1295943181 | Joshua Walter Brownlee | Pediatrics | 200 Patewood Dr, Ste A200, Greenville, SC 29615-3593 | 2007-05-21 |
| 1679681621 | Sandra L Fowler | Pediatrics | 171 Ashley Ave, Charleston, SC 29425-0001 | 2006-08-29 |
| 1457396053 | Laure A.n. Utecht | Pediatrics | 200 Patewood Dr, Suite A200, Greenville, SC 29615-3593 | 2006-06-18 |
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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.