NPIMap

Individual provider Active NPI

Tracy B Reeves, PA

  • Physician Assistant
  • Goose Creek, SC
National Provider Identifier
1053526772
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
648 Issued in SC
Practice address
110 Nnptc Cir
Goose Creek, SC 29445-6314
Phone
(843) 794-6840
Fax
(843) 794-6036
NPI assigned
May 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 648 SC Primary

Addresses

Primary practice location

110 Nnptc Cir
Goose Creek, SC 29445-6314

Mailing address

110 Nnptc Cir
Goose Creek, SC 29445-6314
Phone (843) 636-1765

Other identifiers 2

IdentifierTypeStateIssuer
P00846491OtherSCRR - MEDICARE#
0682PAMedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070810000583 SC Practitioner - Physician Assistant 0143311712 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Family Care IncGroup PAC ID 4587557731, 81 clinicians

Practice addresses (Care Compare)

1208 Two Island CT
Mount Pleasant, SC 29466-7436
Phone (843) 884-6653

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
648SCMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Family Care, Inc CurrentSince Jan 1, 2026 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Jul 1, 2010 Accepting new patients
Carolina Family Care, Inc CurrentSince Jan 1, 2026 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Jul 1, 2010 Accepting new patients
Palmetto Internal Medicine of Summerville PC Current Accepting new patients

Locations

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

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

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

201 Oakbrook Ln
Ste 255
Summerville, SC 29485
Phone (843) 695-8464

201 Sigma Dr
Ste 100
Summerville, SC 29486
Phone (843) 820-3397

Organizations & group practices 6

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 7

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": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1053526772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 NNPTC CIR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294456314",
            "telephone_number": "843-636-1765",
            "fax_number": "843-794-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 NNPTC CIR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294456314",
            "telephone_number": "843-794-6840",
            "fax_number": "843-794-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REEVES",
        "first_name": "TRACY",
        "middle_name": "B",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR - MEDICARE#",
            "identifier": "P00846491",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0682PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goose Creek, SC

Sources for this page

Verify at the official NPI Registry.