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8761 Dorchester Rd Ste 230 Charleston SC 29420-7322 | |
| (843) 471-2273 | |
| (843) 377-8180 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 8761 Dorchester Rd Ste 230, Charleston, South Carolina |
| Authorized Official Name and Position | Lissa C Lara (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8434121590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8761 Dorchester Rd Suite 230 Charleston SC 29420-7321 Ph: (843) 412-1590 | 8761 Dorchester Rd Ste 230 Charleston SC 29420-7322 Ph: (843) 471-2273 |
| NPI Number | 1700162203 |
|---|---|
| Provider Enumeration Date | 10/27/2011 |
| Last Update Date | 07/22/2019 |
| Medicare PECOS PAC ID | 0840466017 |
|---|---|
| Medicare Enrollment ID | O20120110000683 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700162203 | NPI | - | NPPES |
| G50785 | Medicaid | SC | |
| SC6924A634 | Other | SC | MEDICARE PTAN |
| GP6738 | Medicaid | SC |
| Provider Name | Barry S Katz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942266507 PECOS PAC ID: 1254235047 Enrollment ID: I20031124000122 |
| Provider Name | Dana L Katz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720045461 PECOS PAC ID: 0648179606 Enrollment ID: I20040108000252 |
| Provider Name | Laura L Kinney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386609931 PECOS PAC ID: 7810881802 Enrollment ID: I20040219000564 |
| Provider Name | Patricia A Campbell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326088816 PECOS PAC ID: 8224021233 Enrollment ID: I20040406000618 |
| Provider Name | Donald T Hanna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689639072 PECOS PAC ID: 6901798701 Enrollment ID: I20040414001393 |
| Provider Name | Kimberly D Rakes-stephens |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457354888 PECOS PAC ID: 1557356268 Enrollment ID: I20040420000675 |
| Provider Name | Temisan Leslie Etikerentse |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710986757 PECOS PAC ID: 0244126662 Enrollment ID: I20040427000113 |
| Provider Name | Claudius S Dawson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780675306 PECOS PAC ID: 0648249508 Enrollment ID: I20040928000316 |
| Provider Name | Allen B Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902866965 PECOS PAC ID: 1759349376 Enrollment ID: I20050105000010 |
| Provider Name | Michael Chandler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205937521 PECOS PAC ID: 9032150198 Enrollment ID: I20050518001157 |
| Provider Name | Jan H Burger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215001979 PECOS PAC ID: 6709815996 Enrollment ID: I20050808001082 |
| Provider Name | James A Lipke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265476923 PECOS PAC ID: 5597762369 Enrollment ID: I20061109000086 |
| Provider Name | Christine E Houser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679642870 PECOS PAC ID: 9830197078 Enrollment ID: I20061122000034 |
| Provider Name | David Carlos Rodriguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952399222 PECOS PAC ID: 8921008806 Enrollment ID: I20061227000005 |
| Provider Name | John J Forney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548240559 PECOS PAC ID: 2769473123 Enrollment ID: I20070117000214 |
| Provider Name | Sherry Jane Famorca Viduya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538125315 PECOS PAC ID: 8921102344 Enrollment ID: I20070323000569 |
| Provider Name | Skye N Deberry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710943584 PECOS PAC ID: 8123119799 Enrollment ID: I20080314000124 |
| Provider Name | Thomas N Howard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609872803 PECOS PAC ID: 3971574476 Enrollment ID: I20080318000878 |
| Provider Name | Matthew J Kornegay |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922042654 PECOS PAC ID: 9032113485 Enrollment ID: I20081112000080 |
| Provider Name | Hugh Dowdy Durrence |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750551206 PECOS PAC ID: 6204867278 Enrollment ID: I20100723000614 |
| Provider Name | Heather Rose Dawson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396705034 PECOS PAC ID: 3072709708 Enrollment ID: I20101120000145 |
| Provider Name | Jeffrey G Schultze |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881660918 PECOS PAC ID: 8921287731 Enrollment ID: I20110126000402 |
| Provider Name | Brigid Eileen Sullivan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801057294 PECOS PAC ID: 0840461158 Enrollment ID: I20110919000052 |
| Provider Name | Douglas H Gleaton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124226006 PECOS PAC ID: 8628240710 Enrollment ID: I20111014000240 |
| Provider Name | Jennifer Darden Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437411097 PECOS PAC ID: 5698921062 Enrollment ID: I20120820000205 |
| Provider Name | Corynne A Boyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912138983 PECOS PAC ID: 1153477070 Enrollment ID: I20121101000445 |
| Provider Name | Melissa M Meador |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518365899 PECOS PAC ID: 0042530792 Enrollment ID: I20150520000261 |
| Provider Name | Esther Perlmutter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356647861 PECOS PAC ID: 7214100031 Enrollment ID: I20160315002250 |
| Provider Name | Anna Pruitt |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023057676 PECOS PAC ID: 3971887787 Enrollment ID: I20170222002354 |
| Provider Name | John Burton Tiffany |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386616084 PECOS PAC ID: 1951459692 Enrollment ID: I20180320000002 |
| Provider Name | Michelle Ann Price |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184117889 PECOS PAC ID: 4688923410 Enrollment ID: I20180828000133 |
| Provider Name | Rachael Wills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841853728 PECOS PAC ID: 0840526323 Enrollment ID: I20190722000750 |
| Provider Name | Thomas Joseph Maino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659323640 PECOS PAC ID: 2668403460 Enrollment ID: I20200115001309 |
| Provider Name | Christine H Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568740835 PECOS PAC ID: 1254502438 Enrollment ID: I20201006002426 |
| Provider Name | Michael Majetic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629577119 PECOS PAC ID: 3678834538 Enrollment ID: I20201116000989 |
| Provider Name | Chasidy Lynn Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235755984 PECOS PAC ID: 7719372689 Enrollment ID: I20220314000168 |
| Provider Name | Ashley N Ehlers-isenhower |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568131050 PECOS PAC ID: 0143603480 Enrollment ID: I20220818001630 |
| Provider Name | Christopher Koke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386958080 PECOS PAC ID: 1658527577 Enrollment ID: I20221207001498 |
| Provider Name | Stephanie B Xavier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578284311 PECOS PAC ID: 4486023538 Enrollment ID: I20221212001562 |
| Provider Name | Karishma Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932897956 PECOS PAC ID: 3274993159 Enrollment ID: I20230725000147 |
| Provider Name | Rachel Michelle Friend |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235829540 PECOS PAC ID: 0749642023 Enrollment ID: I20230817004189 |
| Provider Name | Aniko Sztankovics Feldman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396425161 PECOS PAC ID: 4385007491 Enrollment ID: I20230822003842 |
| Provider Name | Sarah Harlan Zourzoukis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912604380 PECOS PAC ID: 7911355714 Enrollment ID: I20231204002156 |
| Provider Name | Emily Caroline Cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326815291 PECOS PAC ID: 7517301351 Enrollment ID: I20240220001872 |
| Provider Name | Ludny Charles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750958096 PECOS PAC ID: 0345646980 Enrollment ID: I20240909004660 |
| Provider Name | Briana Luxem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396578183 PECOS PAC ID: 4789116559 Enrollment ID: I20241017002726 |
| Provider Name | Jin Hope Ayer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801615711 PECOS PAC ID: 5092248914 Enrollment ID: I20241031000845 |
Palmetto Primary Care Physicians, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2097 Henry Tecklenburg Dr, Charleston, SC 29414 Phone: 843-572-7727 Fax: 843-569-5881 | |
Harold R Nicolette, Do, Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6 Carriage Ln, Suite B, Charleston, SC 29407 Phone: 843-766-4100 Fax: 843-571-4177 | |
Empowerme Medical Group, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2333 Ashley River Rd, Charleston, SC 29414 Phone: 877-367-9772 | |
Medical University Of South Carolina Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 60 Barre St, Charleston, SC 29401 Phone: 901-292-7077 |