Individual provider Active NPI

Manuel Augusto Valdebran Canales

  • Dermatology Physician
  • Summerville, SC
National Provider Identifier
1013553957
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4383413 Issued in SC
Practice address
5500 Front St Ste 440
Summerville, SC 29486-8137
Phone
(843) 985-3565
Fax
(843) 985-9389
NPI assigned
Nov 26, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 4383413 SC Primary

Addresses

Primary practice location

5500 Front St Ste 440
Summerville, SC 29486-8137

Mailing address

PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200122001034 SC Practitioner - Dermatology 4183059181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Hospital & facility affiliations

  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

Merit-based Incentive Payment System (MIPS)

Final score
79.02 of 100Reported as group
Quality
62.41
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions501
Removal or shaving of skin growth16
Skin biopsy248

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4383413SCMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol CurrentSince Nov 20, 2019 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Nov 20, 2019 Accepting new patients

Locations

135 Rutledge Ave
Fl 11
Charleston, SC 29425
Phone (843) 792-3021

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

5500 Front St
Ste 440
Summerville, SC 29486
Phone (843) 985-3565

Interoperability endpoints

  • Direct secure messaging: mvaldebran287635@direct.musc.edu

Organizations & group practices 2

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

Hospital & facility affiliations 6

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": "1574726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1013553957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 FRONT ST STE 440",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294868137",
            "telephone_number": "843-985-3565",
            "fax_number": "843-985-9389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALDEBRAN CANALES",
        "first_name": "MANUEL",
        "middle_name": "AUGUSTO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-26",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SC",
            "license": "4383413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

Verify at the official NPI Registry.