NPIMap

Individual provider Active NPI

Ian Michael Carrese, PA-C

  • Physician Assistant
  • Lancaster, SC
National Provider Identifier
1003251562
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1939 Issued in SC
Practice address
800 W Meeting St
Lancaster, SC 29720-2202
Phone
(843) 792-1414
NPI assigned
May 9, 2013
Last updated
Jun 24, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X 1939 SC Primary

Addresses

Primary practice location

800 W Meeting St
Lancaster, SC 29720-2202

Mailing address

PO Box 935722
Atlanta, GA 31193-5722
Phone (843) 792-6200

Other practice location 1

1304 W Bobo Newsom Hwy
Hartsville, SC 29550-4710
Phone (843) 339-2100

Other names 1

  • Ian Michael Goodsell Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130806000442 SC Practitioner - Physician Assistant 2163664095 Reassigns benefits to 5 organizations
I20180507002566 AZ Practitioner - Physician Assistant 2163664095 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

506 N St
Bamberg, SC 29003-1319
Phone (803) 245-6290

805 Pamplico Hwy
Florence, SC 29505-6047

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
53961CAMDOrthodontics and Dentofacial Orthopedic Dentist
6673AZMDPhysical Therapist
1939SCMDPhysical Rehabilitation Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Family Care, Inc CurrentSince Jul 10, 2020 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Jun 22, 2020 Accepting new patients
Carolina Family Care, Inc CurrentSince Jul 10, 2020 Accepting new patients
Musc Community Physicians CurrentSince Apr 30, 2022 Accepting new patients
University Medical Associates of the Medical University of South Carol Physician Assistant CurrentSince Jun 22, 2020 Accepting new patients
Musc Community Physicians CurrentSince Apr 30, 2022 Accepting new patients
Riverside Family Clinic Past Accepting new patients
Northeast Montana Health Services, Inc. Past Accepting new patients
Wolf Point Clinic Association Inc Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

800 W Meeting St
Lancaster, SC 29720
Phone (803) 286-1214

1341 Old Georgetown Rd
Ste C
Mt Pleasant, SC 29464
Phone (843) 884-2175

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 15

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1003251562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 935722",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311935722",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W MEETING ST",
            "city": "LANCASTER",
            "state": "SC",
            "postal_code": "297202202",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1304 W Bobo Newsom Hwy",
            "address_purpose": "LOCATION",
            "city": "Hartsville",
            "state": "SC",
            "postal_code": "295504710",
            "country_code": "US",
            "telephone_number": "843-339-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARRESE",
        "first_name": "IAN",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-09",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "800 W Meeting St",
            "city": "Lancaster",
            "state": "SC",
            "country_code": "US",
            "postal_code": "297202202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "IAN",
            "last_name": "GOODSELL",
            "middle_name": "MICHAEL",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lancaster, SC

Sources for this page

Verify at the official NPI Registry.