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MALISSA WILSON ETHEREDGE M.D.
NPI 1811301203
Internal Medicine in Columbia, SC

Active since June 13, 2014PECOS Enrolled
100 PALMETTO HEALTH PKWY STE G100, COLUMBIA, SC 29212(803) 434-1210(803) 434-1212 Get Directions Write a Review

NPPES record last updated: December 27, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 27, 2018, Dec 12, 2018, Nov 14, 2018 (3 updates tracked since 2018).

About Malissa Wilson Etheredge M.d. NPPES

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

MALISSA WILSON ETHEREDGE M.D. (NPI 1811301203) is an individual internal medicine provider in Columbia, South Carolina, licensed in South Carolina (37102) and active in the NPI registry since June 2014. She is enrolled in Medicare PECOS and maintains a secondary practice location in Columbia.

NPPES Registry Identity

NPI1811301203
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameMALISSA WILSON ETHEREDGECredential: M.D.
Location Address100 PALMETTO HEALTH PKWY STE G100Columbia, SC 29212-1754
Mailing AddressPo Box 743904Atlanta, GA 30374-3904 · (803) 296-7320 · Fax (803) 296-7330
Phone(803) 434-1210
Fax(803) 434-1212
Sole ProprietorNo
Enumeration DateJune 13, 2014
Last NPPES UpdateDecember 27, 20183 updates tracked since enumeration
✔ NPI 1811301203 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Licenses✔ Licensed in SC · 37102✔ Licensed in SC · LL37102
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
100 PALMETTO HEALTH PKWY STE G100, Columbia, SC 29212
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Other Names 1

Former Name (1)Malissa Blair Wilson Md

Secondary Practice Location 1

Location 11801 Sunset Drive, Internal Medicine ClinicColumbia, SC 29203 · Phone (803) 434-4153 · Fax (803) 434-4160

Other Identifiers 1

Medicaid371029SC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of South Carolina.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Malissa Wilson Etheredge M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29212 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$124.04 typical visit price
range $53.57 – $163.84
Typical copayment $31.01 (range $13.39 – $40.96)
Most-billed visit code 99204
Established Patient
$95.12 typical visit price
range $16.96 – $133.52
Typical copayment $23.78 (range $4.24 – $33.38)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

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

ALIYA POKU AGYEMANG NP
Nurse Practitioner
100 PALMETTO HEALTH PKWY STE G100
COLUMBIA, SC 29212
Lexington County (803) 907-7850
LILY CHOZICK
Physician Assistant (Medical)
100 PALMETTO HEALTH PKWY STE G100
COLUMBIA, SC 29212
Lexington County (803) 907-7850
SARA ANN RITENOUR NP
Nurse Practitioner (Acute Care)
100 PALMETTO HEALTH PKWY STE G100
COLUMBIA, SC 29212
Lexington County (803) 907-7850

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Malissa Etheredge's NPI number?

The NPI number for Malissa Etheredge is 1811301203. It was assigned to this individual provider in the NPPES registry on June 13, 2014. The provider is also known as Malissa Blair Wilson MD.

Where is Malissa Etheredge located?

Malissa Etheredge practices at 100 Palmetto Health Pkwy Ste G100, Columbia, SC 29212. The listed phone number is (803) 434-1210.

What is Malissa Etheredge's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Malissa Etheredge enrolled in Medicare?

Yes. Malissa Etheredge is registered in the Medicare PECOS enrollment system.

What insurance does Malissa Etheredge accept?

Health plans from BlueCross BlueShield of South Carolina list Malissa Etheredge as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Malissa Etheredge was last updated on December 27, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years 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.