NPIMap

Organization Active NPI

Medical University Hospital Authority

  • Rural Health Clinic/Center
  • Mullins, SC
National Provider Identifier
1043837669
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Practice address
511 S Main St
Mullins, SC 29574-3509
Phone
(843) 464-8244
NPI assigned
Jun 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

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

Authorized official

Name
Karyn Rae
Title
Chief
Phone
(843) 876-1344

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

511 S Main St
Mullins, SC 29574-3509

Mailing address

PO Box 23467
New York, NY 10087-3467
Phone (843) 792-6200

Other practice location 1

1 Medical Park Dr
Chester, SC 29706-9769
Phone (803) 581-3151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031215000499 SC Part B Supplier - Clinic/Group Practice 1557268950 Receives reassigned benefits from 365 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lancaster, SC; Richburg, SC; Mullins, SC; Mount Pleasant, SC; Marion, SC; Lake City, SC; Charleston, SC; Kingstree, SC…
O20201216000458 SC Part A Provider - Rural Health Clinic 1557268950 Practice locations: Mullins, SC

Rural health clinic certification: CCN 423488

Legal name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Doing business as
MUSC HEALTH PRIMARY CARE MULLINS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 22, 2021
Last certification
Apr 24, 2024
Ownership / control type
1B
Organization structure
OtherNon-profit
Enrollment address
511 S Main St
Mullins, SC 29574-3509
Related CCNs
420019

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lisa M Goodlett Individual Corporate OfficerCfo Mar 1, 2019
Sonya Floyd Individual W-2 Managing Employee Mar 12, 2019
Karyn Rae Individual Corporate DirectorDirector Mar 12, 2019
Patrick J Cawley Individual Corporate OfficerCeo Mar 1, 2019

All facility ownership & control disclosures 11

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

FacilityTypeRoleSince
Tidelands Waccamaw Community HospitalMurrells Inlet, SC, CCN 420098 Hospital Operational/Managerial Control Oct 1, 2025
Tidelands Georgetown Memorial HospitalGeorgetown, SC, CCN 420020 Hospital Operational/Managerial Control Oct 1, 2025
Musc Health Lancaster Medical CenterLancaster, SC, CCN 429803 Hospital Operational/Managerial Control (100%) Mar 1, 2019
Musc Health Lancaster Rehabilitation CenterLancaster, SC, CCN 42T036 Hospital Operational/Managerial Control (100%) Mar 1, 2019
Tidelands Georgetown Memorial HospitalGeorgetown, SC, CCN 42U020 Hospital Operational/Managerial Control Oct 1, 2025
Tidelands Health Family Medicine at GeorgetownGeorgetown, SC, CCN 428958 Rural health clinic Operational/Managerial Control Oct 1, 2020
Tidelands Health Family Medicine at HemingwayHemingway, SC, CCN 423859 Rural health clinic Operational/Managerial Control Oct 1, 2025
Tidelands Health Family MedicineAndrews, SC, CCN 423970 Rural health clinic Operational/Managerial Control Oct 1, 2025
Tidelands Health Family Medicine at Pawleys IslandPawleys Island, SC, CCN 423870 Rural health clinic Operational/Managerial Control Oct 1, 2025
Musc Health Primary Care - Thurgood Marshall BlvdKingstree, SC, CCN 423448 Rural health clinic Operational/Managerial Control (100%) Dec 1, 2022
Musc Community PhysiciansBranchville, SC, CCN 423856 Rural health clinic Operational/Managerial Control (100%) Aug 1, 2021

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663891200000",
    "number": "1043837669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23467",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873467",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 S MAIN ST",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295743509",
            "telephone_number": "843-464-8244"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Park Dr",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "SC",
            "postal_code": "297069769",
            "country_code": "US",
            "telephone_number": "803-581-3151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDICAL UNIVERSITY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-30",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "843-876-1344"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mullins, SC

Sources for this page

Verify at the official NPI Registry.