PROVIDENCE GROUP PRACTICES II, LLC (NPI# 1396192001) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396192001 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE GROUP PRACTICES II, LLC |
| Other Organization Name | PROVIDENCE HEART |
| Practice Address |
1655 Bernardin Ave Ste 220 Columbia SC 29204-2039 |
| Mailing Address |
114 Gateway Corporate Blvd Ste 425 Columbia SC 29203-9740 |
| Practice Telephone | 8034097170 |
| Practice Fax Number | 8034097175 |
| Mailing Telephone | 8038654780 |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2017-02-23 |
| Authorized Official Name | JESS N JUDY (PRESIDENT) |
| Authorized Official Telephone | 6159207000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207UN0901X |
Nuclear Medicine Specialization: Nuclear Cardiology |
Allopathic & Osteopathic Physicians | ||
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PROVIDENCE HEART | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184133258 | Providence Group Practices II, LLC | Internal Medicine | 1330 Haile St, Camden, SC 29020-3002 | 2017-09-21 |
| Street Address |
1655 BERNARDIN AVE STE 220 |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29204-2039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235138819 | Stephen Harmes Humphrey | Internal Medicine | 1655 Bernardin Ave, Suite 220, Columbia, SC 29204-2039 | 2005-07-18 |
| 1194264465 | Anna M Evans | Nurse Practitioner | 1655 Bernardin Ave, Pmob 3 Suite 220, Columbia, SC 29204-2039 | 2017-02-19 |
| 1760934673 | Falguni Patel | Physician Assistant | 1655 Bernardin Ave, Ste 240, Columbia, SC 29204-2039 | 2016-10-26 |
| 1689034548 | Providence Physician Practices LLC | Plastic Surgery | 1655 Bernardin Ave, Ste 110, Columbia, SC 29204-2039 | 2016-03-04 |
| 1790143766 | Providence Physician Practices LLC | Internal Medicine | 1655 Bernardin Ave, Ste 350, Columbia, SC 29204-2039 | 2016-02-05 |
| 1629457650 | Palmetto Pain Management, LLC | Non-Pharmacy Dispensing Site | 1655 Bernardin Ave, Suite 240, Columbia, SC 29204-2039 | 2015-05-22 |
| 1023410370 | Sabrina Marina Hilbert | Nurse Practitioner | 1655 Bernardin Ave, Suite 350, Columbia, SC 29204-2039 | 2014-09-18 |
| 1568899581 | Augustine Health Group | Surgery | 1655 Bernardin Ave, Suite 110, Columbia, SC 29204-2039 | 2013-10-04 |
| 1073833489 | Providence Pulmonary Specialists, LLC | Internal Medicine | 1655 Bernardin Ave, Suite 350, Columbia, SC 29204-2039 | 2010-06-08 |
| 1831414481 | Beau Taylor Bryan | Ophthalmology | 1655 Bernardin Ave, Suite 100, Columbia, SC 29204-2039 | 2010-04-06 |
| Find all providers in the same location | ||||
| 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 | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710189592 | Trung Tran | Internal Medicine | 1605 E Broadway, Suite 300, Columbia, MO 65201-8023 | 2007-06-04 |
| 1760500987 | Michael Allen Brown | Internal Medicine | 1605 E Broadway, Suite 300, Columbia, MO 65201-8023 | 2007-03-26 |
| 1306869060 | Ian Smith | Internal Medicine | 1655 Bernardin Ave, Suite 300, Columbia, SC 29204-2039 | 2006-07-25 |
| 1700836202 | South Central Heart Group Inc | Internal Medicine | 1220 Trotwood Ave, Suite 401, Columbia, TN 38401-6433 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003318080 | Cardiac Cin of South Carolina LLC | Internal Medicine | 6650 Rivers Ave Ste 405, North Charleston, SC 29406-4809 | 2018-03-06 |
| 1376834606 | Heart Associate of Hilton Head PC | Internal Medicine | 14 Westbury Park, Suite 103, Bluffton, SC 29910-7461 | 2011-04-20 |
| 1861485088 | Donald E Saunders IIi | Internal Medicine | 4969 Centre Pointe Dr, Suite 100, North Charleston, SC 29418-6952 | 2005-08-23 |
| 1568455723 | Scott L Woodfield | Internal Medicine | 1033 Saint Andrews Blvd, Charleston, SC 29407-7156 | 2005-08-23 |
| 1912400300 | Carolina Cardiology and Vascular Associates LLC | Internal Medicine | 3020 Sunset Blvd Ste 105, West Columbia, SC 29169-3494 | 2018-03-13 |
| 1851656482 | Vinod K Chaubey | Internal Medicine | 2376 Cypress Circle, Suite 102, Conway, SC 29526-8964 | 2012-07-10 |
| 1740569227 | Mohamed Faher Almahmoud | Internal Medicine | 169 Ashley Ave Rm 202, Charleston, SC 29425-0553 | 2011-08-15 |
| 1336439074 | Sebastiano Antonio Virgadamo | Internal Medicine | 1083 Boiling Springs Rd, Spartanburg, SC 29303-2248 | 2011-04-14 |
| 1104123835 | Heart Associate of Hilton Head LLC | Internal Medicine | 35 Hospital Center Cmns, Ste 101, Hilton Head, SC 29926-2845 | 2011-02-15 |
| 1740502822 | Bon Secours St Francis Xavier Hospital, Inc. | Internal Medicine | 2095 Henry Tecklenburg Dr, Charleston, SC 29414-5733 | 2010-02-17 |
| Find all providers with the same taxonomy | ||||
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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.