NORTHLAKE FAMILY MEDICAL PRACTICE (NPI# 1003928680) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003928680 |
| Entity Type | Organization |
| Organization Name | NORTHLAKE FAMILY MEDICAL PRACTICE |
| Practice Address |
3000 Ne Medical Park Ste 101 Columbia SC 29223-6251 |
| Practice Telephone | 8034195131 |
| Practice Fax Number | 8034195130 |
| Mailing Telephone | 8034195131 |
| Mailing Fax Number | 8034195130 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-10-16 |
| Authorized Official Name | DR. REGINALD L PARKER (OWNER) |
| Authorized Official Telephone | 8034195131 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 14862 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP4438 | 05 |
| Street Address |
3000 NE MEDICAL PARK STE 101 |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29223-6251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821094772 | James F Elmore | Internal Medicine | 3000 Ne Medical Park, Suite 108, Columbia, SC 29223-6251 | 2005-06-24 |
| 1083858708 | Linda Smith Shealy | Nurse Practitioner | 3000 Ne Medical Park, Suite 212, Columbia, SC 29223-6251 | 2009-04-24 |
| 1972753408 | Shagufta Yasmin Chaudhry | Family Medicine | 3000 Ne Medical Park, Suite 209, Columbia, SC 29223-6251 | 2008-09-20 |
| 1790947596 | Melissa Boylan | Family Medicine | 3000 Ne Medical Park, Suite 209, Columbia, SC 29223-6251 | 2008-07-02 |
| 1972701860 | Peter Richard Kilmann | Psychologist | 3000 Ne Medical Park, Suite 204, Columbia, SC 29223-6251 | 2007-07-03 |
| 1720130792 | Lisa Ann Bright Zynczak | Physical Medicine & Rehabilitation | 3000 Ne Medical Park, Ste 202, Columbia, SC 29223-6253 | 2007-01-18 |
| 1528140373 | Tpcg, Inc | Clinic/Center | 3000 Ne Medical Park, Suite 109, Columbia, SC 29223-6251 | 2006-10-20 |
| 1295822856 | Columbia Rehabilitation Clinic | Physical Medicine & Rehabilitation | 3000 Ne Medical Park, Ste 202, Columbia, SC 29223-6251 | 2006-10-06 |
| 1861504441 | Sandhills Family Medicine, PC | Family Medicine | 3000 Ne Medical Park, Ste 101, Columbia, SC 29223-6251 | 2006-08-31 |
| 1174544886 | Palmetto Health | Internal Medicine | 3000 Ne Medical Park, Suite 108, Columbia, SC 29223-6251 | 2006-07-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619522794 | Timothy Drew Edwards | Dentist | 122 N. Brickyard Rd, Columbia, SC 29223 | 2019-08-06 |
| 1861983249 | Southern Pain Specialists | Physical Medicine & Rehabilitation | 115 Blarney Dr Ste 111, Columbia, SC 29223 | 2018-05-22 |
| 1710481452 | Evans Counseling and Consulting, LLC | Social Worker | 120 Wildewood Park Dr Ste A, Columbia, SC 29223 | 2018-03-19 |
| 1750824819 | Marquita Heyward | Counselor | 1 Winsor Cove Suite 303, Columbia, SC 29223 | 2016-11-22 |
| 1578015509 | Carolina Family Pharmacy, LLC | Pharmacy | 9153 Two Notch Road, Columbia, SC 29223 | 2016-10-25 |
| 1225485170 | Lisa Diaz | Occupational Therapy Assistant | 7601 Parlane Rd, Columbia, SC 29223 | 2016-05-20 |
| 1295199859 | Sarah Ann Riley | Nurse Practitioner | Cvs Pharmacy 121 Clemson Rd., Columbia, SC 29223 | 2016-04-11 |
| 1134583214 | Sara Alisha Pound | Behavioral Analyst | 97b Winterberry Ln, Columbia, SC 29223 | 2016-04-05 |
| 1508227653 | Lucy Elvira Vicioso-harris | Counselor | 1310 Oakcrest Dr Apt 318, Columbia, SC 29223 | 2016-03-17 |
| 1134585243 | Robin Heaton | Occupational Therapy Assistant | 7601 Parklane Road, Columbia, SC 29223 | 2016-01-05 |
| Find all providers in zip 29223 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447868005 | Brittany Mechelle Waterworth | Family Medicine | 3700 I 70 Dr Se Ste 106, Columbia, MO 65201-6587 | 2020-07-20 |
| 1730706839 | John James Gannon | Family Medicine | Prisma Health Medical Group Family Medicine, 3209 Colonial Drive, Columbia, SC 29203 | 2020-07-06 |
| 1053938852 | Garrison Glenn Rice | Family Medicine | Prisma Health Medical Group Family Medical Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-29 |
| 1457977563 | Jenny Tatiana Gonzalez Guzman | Family Medicine | Prisma Health Family Medical Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-24 |
| 1942825500 | Jarvis Jamal Johnson | Family Medicine | Prisma Health Family Medicine Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-10 |
| 1386268183 | Nicolas Anthony Limogiannis | Family Medicine | Prisma Health Medical Group Family Medicine Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-08 |
| 1730724220 | Luci Lee Redman Cassella | Family Medicine | 8900 Columbia 100 Parway Suite G, Columbia, MD 21045 | 2019-11-08 |
| 1275177420 | Palmetto Primary Care Physicians | Family Medicine | 1415 Blanding St Ste 2, Columbia, SC 29201-2922 | 2019-10-31 |
| 1558919852 | Synergos Medical, LLC | Family Medicine | 1703 Oak Cliff Pl, Columbia, MO 65203-4719 | 2019-08-29 |
| 1972156982 | Maury Regional Medical Group, Inc | Family Medicine | 2478 Nashville Hwy Ste A, Columbia, TN 38401-0634 | 2019-07-18 |
| 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.