HALEY TIEDEMANN PA-C
NPI 1568317329
Physician Assistant - Surgical in Columbia, SC

Q: What is Haley Tiedemann's NPI number?

The NPI number for Haley Tiedemann is 1568317329. It was assigned to this individual provider in the NPPES registry on February 26, 2026.

Q: What is Haley Tiedemann's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for Haley Tiedemann was last updated on May 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 26, 2026PECOS Enrolled

14 RICHLAND MEDICAL PARK DR STE 310, COLUMBIA, SC 29203(803) 434-8450(803) 434-0137 Get Directions Write a Review

NPPES record last updated: May 28, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Haley Tiedemann Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HALEY TIEDEMANN PA-C (NPI 1568317329) is an individual surgical provider in Columbia, South Carolina, licensed in South Carolina (6264) and active in the NPI registry since February 2026. She is enrolled in Medicare PECOS, maintains a secondary practice location in Ashland, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1568317329

Entity TypeIndividualFemale

Primary Taxonomy363AS0400X

Provider Legal NameHALEY TIEDEMANNCredential: PA-C

Location Address14 RICHLAND MEDICAL PARK DR STE 310Columbia, SC 29203-6883

Mailing Address300 E Mcbee Ave Fl 4Greenville, SC 29601-2842 · (864) 695-6697

Phone(803) 434-8450

Fax(803) 434-0137

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateFebruary 26, 2026

Last NPPES UpdateMay 28, 2026

NPPES CertifiedMay 28, 2026

✔ NPI 1568317329 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

License✔ Licensed in SC · 6264

Also ListedPhysician AssistantTaxonomy 363A00000X · License 6264 (SC)

14 RICHLAND MEDICAL PARK DR STE 310, Columbia, SC 29203

Open in Google Maps ↗

Secondary Practice Location 1

Location 1114 College AveAshland, VA 23005 · Phone (804) 752-8878

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Haley Tiedemann Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1456827880

PECOS Enrollment IDI20260414002142

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ARGIRI X BROOK MD

Pediatrics