NPIMap

Individual provider Active NPI

Brian Thomas Trezak, MD

  • Internal Medicine Physician
  • Florence, SC
National Provider Identifier
1003913526
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
17416 Issued in NH
Practice address
805 Pamplico Hwy
Florence, SC 29505-6047
Phone
(843) 792-1414
NPI assigned
Sep 19, 2006
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21385 SC
Internal Medicine Physician 207R00000X MD28278 ME
Internal Medicine Physician 207R00000X 2007-000516 NC
Internal Medicine Physician 207R00000X 62579 CT
Internal Medicine Physician 207R00000X 17416 NH Primary

Addresses

Primary practice location

805 Pamplico Hwy
Florence, SC 29505-6047

Mailing address

PO Box 23321
New York, NY 10087-3221
Phone (843) 792-1414

Other practice location 1

1843 Quiet Cove
Fayetteville, NC 28304-3857
Phone (910) 483-8080 ext. 113

Other practice location 2

789 Central Ave
Dover, NH 03820-2526
Phone (603) 740-2503

Other practice location 3

321 Mulberry St SW
Lenoir, NC 28645
Phone (828) 757-5504

Other practice location 4

267 Grant St
Bridgeport, CT 06610-2805
Phone (203) 384-4677

Other identifiers 1

IdentifierTypeStateIssuer
213851MedicaidSC

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, NH, ME3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20050124000901 SC Practitioner - Internal MedicinePractitioner - Hospitalist 1759331168 Reassigns benefits to 2 organizations
I20160928001206 NH Practitioner - Internal MedicinePractitioner - Hospitalist 1759331168 Reassigns benefits to 4 organizations
I20240829000488 ME Practitioner - Internal Medicine 1759331168 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of Ny Upstate Medical University, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vantage Healthcare LLCGroup PAC ID 8224361191, 72 clinicians

Practice addresses (Care Compare)

10 White Oak Dr
Exeter, NH 03833-5318
Phone (603) 658-3073

100 Sterling Way
Dover, NH 03820-4571
Phone (603) 570-9390

15 Riverwoods Dr
Exeter, NH 03833-5310
Phone (603) 742-4700

150 Garrison Rd
Dover, NH 03820-4590
Phone (603) 515-8888

206 N River Rd
Lee, NH 03861-6214
Phone (603) 292-5509

22 Tuck Rd
Hampton, NH 03842-1225
Phone (781) 867-2050

35 Pointe PL
Dover, NH 03820-4742
Phone (844) 325-8230

5 Timber LN
Exeter, NH 03833-5331
Phone (603) 742-4700

7 Riverwoods Dr
Exeter, NH 03833-4374
Phone (603) 742-4700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD28278MEMDInternal Medicine Physician
2007-000516NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Regional Medical Center of the Pee Dee, Inc Internal Medicine CurrentSince Aug 9, 2021 Accepting new patients
Musc Community Physicians CurrentSince Dec 1, 2022 Accepting new patients
Alignmed Medical Group, PC CurrentSince Aug 25, 2024 Accepting new patients
Vantage Healthcare LLC Internal Medicine CurrentSince Feb 1, 2024 Accepting new patients
Vantage Healthcare Inc Internal Medicine CurrentSince Aug 18, 2024 Accepting new patients
Genesis Eldercare Physician Services LLC CurrentSince Mar 5, 2024 Accepting new patients
Musc Community Physicians Internal Medicine Current Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince Aug 9, 2021 Accepting new patients
Musc Community Physicians Internal Medicine CurrentSince Dec 1, 2022 Accepting new patients
Post Acute Specialists, LLC Internal Medicine Past Accepting new patients
Dover SNF Opco LLC Past Accepting new patients
Sentry Commons LLC Past Accepting new patients
Mount Carmel Rehabilitation & Nursing Center Past Accepting new patients
Saint Joseph Residence Past Accepting new patients
Warde Rehabilitation and Nursing Center Past Accepting new patients
St Teresa Rehabilitation & Nursing Center Past Accepting new patients
Kennebunk Operations, LLC Past Accepting new patients

Locations

9 Lewis Rd
Kittery, ME 03904
Phone (207) 439-9800

33 Roger St
Lewiston, ME 04240
Phone (207) 784-0108

30 Colby Ct
Bedford, NH 03110
Phone (603) 267-0527

239 Pleasant St
Concord, NH 03301
Phone (603) 224-6561

22 Tuck Rd
Hampton, NH 03842
Phone (603) 926-4551

175 Blueberry Ln
Laconia, NH 03246
Phone (603) 524-3340

24 Old Etna Rd
Lebanon, NH 03766
Phone (603) 442-4207

191 Hackett Hill Rd
Manchester, NH 03102
Phone (603) 600-3255

22 Hunt St
Nashua, NH 03060
Phone (603) 889-5450

8 Snow Rd
Winchester, NH 03470
Phone (603) 239-6355

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

555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233

805 Pamplico Hwy
Florence, SC 29505
Phone (843) 674-2500

805 Pamplico Hwy
Ste A220
Florence, SC 29505
Phone (803) 664-9393

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Langdon Place of DoverDover, NH, CCN 305089 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 1, 2024
Sep 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Dover SNF Opco LLC

    dba Langdon Place of Dover

    • Skilled Nursing Facility
    • Dover, NH
    • NPI 1316772601

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

Organizations & group practices 19

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 19

Hospital & facility affiliations 12

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": "1158624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1003913526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23321",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873221",
            "telephone_number": "843-792-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 PAMPLICO HWY",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056047",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1843 Quiet Cove",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043857",
            "country_code": "US",
            "telephone_number": "910-483-8080 x113",
            "fax_number": "910-483-3258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "789 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "NH",
            "postal_code": "038202526",
            "country_code": "US",
            "telephone_number": "603-740-2503",
            "fax_number": "910-483-3258",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "321 Mulberry St SW",
            "address_purpose": "LOCATION",
            "city": "Lenoir",
            "state": "NC",
            "postal_code": "28645",
            "country_code": "US",
            "telephone_number": "828-757-5504",
            "fax_number": "828-757-5501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "267 Grant St",
            "address_purpose": "LOCATION",
            "city": "Bridgeport",
            "state": "CT",
            "postal_code": "066102805",
            "country_code": "US",
            "telephone_number": "203-384-4677",
            "fax_number": "203-384-3135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TREZAK",
        "first_name": "BRIAN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-19",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "21385",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "MD28278",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2007-000516",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "62579",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "17416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213851",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "805 Pamplico Hwy",
            "city": "Florence",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295056047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.