Individual provider Active NPI

William J Grossman, M.D.

  • Cardiovascular Disease Physician
  • Charleston, SC
National Provider Identifier
1023068897
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
6926 Issued in SC
Practice address
191 Rutledge Avenue
Charleston, SC 29403
Phone
(843) 723-1614
Fax
(843) 727-2980
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 6926 SC Primary

Addresses

Primary practice location

191 Rutledge Avenue
Charleston, SC 29403

Mailing address

191 Rutledge Avenue
Charleston, SC 29403
Phone (843) 723-1614

Other identifiers 1

IdentifierTypeStateIssuer
069268MedicaidSC

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
I20050405001213 SC Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 5597754101 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6926SCMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Roper Hospital Inc. CurrentSince Nov 1, 2007 Accepting new patients
Roper Hospital, Inc. Current Accepting new patients
Carolina Family Care CurrentSince Jan 8, 2020 Accepting new patients
Carolina Family Care, Inc CurrentSince Jan 8, 2020 Accepting new patients
Roper Hospital, Inc. CurrentSince Nov 1, 2007 Accepting new patients

Locations

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

1600 Midtown Ave
Mt Pleasant, SC 29464
Phone (843) 284-6555

1113 Park West Blvd
Mt Pleasant, SC 29466
Phone (843) 876-1445

1208 Two Island Ct
Mt Pleasant, SC 29466
Phone (843) 884-6653

416 Robertson Blvd
Ste B
Walterboro, SC 29488
Phone (843) 549-2411

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1023068897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 RUTLEDGE AVENUE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29403",
            "telephone_number": "843-723-1614",
            "fax_number": "843-727-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 RUTLEDGE AVENUE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29403",
            "telephone_number": "843-723-1614",
            "fax_number": "843-727-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SC",
            "license": "6926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069268",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.