NPIMap

Organization Active NPI

Musc Community Physicians

Doing business as MUSC Health Primary Care - Branchville

  • Rural Health Clinic/Center
  • Branchville, SC
National Provider Identifier
1043916448
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MUSC COMMUNITY PHYSICIANS
Doing business as
MUSC Health Primary Care - Branchville
Practice address
215 Dorange Rd
Branchville, SC 29432-2241
Phone
(843) 792-1414
NPI assigned
Feb 7, 2023
Last updated
Feb 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

215 Dorange Rd
Branchville, SC 29432-2241

Mailing address

PO Box 23321
New York, NY 10087-3321
Phone (843) 792-6200

Other names 1

  • MUSC Health Primary Care - Branchville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231020002168 SC Part A Provider - Rural Health Clinic 6507260668 Practice locations: Branchville, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043916448. Details of each certification follow.

Rural health clinic certification: CCN 423856

Legal name
MUSC COMMUNITY PHYSICIANS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 1, 1995
Last certification
Oct 20, 2021
Ownership / control type
2B
Most recent change of ownership
Jan 2, 2007 (1 total)
Organization structure
OtherNon-profit
Incorporated
Aug 1, 2021 in SC
Enrollment address
215 Dorange Rd
Branchville, SC 29432-2241

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0251019Musc Health Primary Care - Branchville215 Dorange Road, Branchville, SC 29432Certificate of waiverSep 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Musc Community Physicians10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the 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
Medical University Hospital Authority Organization, Charleston, SC Non-profit Operational/Managerial Control Aug 1, 2021 100%
Sonya Floyd Individual W-2 Managing EmployeeManager Mar 1, 2023
Karyn Rae Individual Corporate DirectorChief Payor Relations and Reimbu Mar 1, 2023 100%
Patrick J Cawley Individual Corporate OfficerCeo Jan 1, 2024 100%

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 1

DateEventCounterparty
Mar 1, 2023 Change of OwnershipThis provider was the buyer RMC Primary Care BranchvilleCCN 423856, SC, NPI 1487701157

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1043916448",
    "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": "100873321",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 DORANGE RD",
            "city": "BRANCHVILLE",
            "state": "SC",
            "postal_code": "294322241",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSC COMMUNITY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "CHIEF, PAYOR RELATIONS",
        "authorized_official_telephone_number": "843-876-1344"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MUSC Health Primary Care - Branchville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Branchville, SC

Sources for this page

Verify at the official NPI Registry.