Charleston Cancer Center PA

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

11628 Issued in SC

Legal business name

CHARLESTON CANCER CENTER PA

Practice address

2910 Tricom St
North Charleston, SC 29406-9350

Phone

(843) 572-9211

Fax

(843) 572-0457

NPI assigned

Aug 8, 2006

Last updated

Feb 15, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Douglas L. Michaelsen, M.D.NPI 1932191269

Title

Managing Partner

Phone

(843) 572-9211

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• Trident Palmetto Hematology Oncology Former legal business name

Locations

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Charleston Cancer Center

  • Hematology & Oncology Physician
  • Mount Pleasant, SC
  • NPI 1073776464
  NPPES parent name
• Charleston Cancer Center

  • Hematology & Oncology Physician
  • Walterboro, SC
  • NPI 1477882843
  NPPES parent name
• Charleston Cancer Center, PA

  • Hematology & Oncology Physician
  • Moncks Corner, SC
  • NPI 1528369667
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Douglas L Michaelsen, MD

  • Hematology & Oncology Physician
  • North Charleston, SC
  • NPI 1932191269
  Authorized official Same address or phone

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1043220627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069350",
            "telephone_number": "843-572-9211",
            "fax_number": "843-572-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069350",
            "telephone_number": "843-572-9211",
            "fax_number": "843-572-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON CANCER CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "MICHAELSEN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "843-572-9211",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "PA2273",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "18607",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "19684",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "32155",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "30018",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "11628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "C612826292",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trident Palmetto Hematology Oncology",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Channel the Beacon
• Demario Andres Chappell
• Charleston Addiction Medicine, LLC
• Charleston Birth Place, Inc
• Charleston Bracing, LLC
• Charleston Children's Therapy Center, LLC
• Charleston Clinical & Health Services, Inc. (Medical Plaza Pharmacy)
• Charleston Counseling LLC
• Charleston County Government (Charleston County EMS)
• Charleston County Government (Charleston Center)

• Hematology & Oncology Physician in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Hematology & Oncology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.