Michael B Carothers, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1922 Issued in SC

Practice address

104 Terrapin Cir
Summerville, SC 29486-8273

Phone

(843) 475-4392

NPI assigned

Oct 17, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Broad River Physicians Group, LLC

  • Emergency Medicine Physician
  • Summerville, SC
  • NPI 1295443000
  Medicare reassignment
• Nason Medical Center IV, LLC

  • Urgent Care Clinic/Center
  • Charleston, SC
  • NPI 1689972739
  NPD (past)
• Nason Medical Center V, LLC

  • Urgent Care Clinic/Center
  • Summerville, SC
  • NPI 1427306299
  NPD (past)

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

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1063797447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 TERRAPIN CIR",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294868273",
            "telephone_number": "843-475-4392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 TERRAPIN CIR",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294868273",
            "telephone_number": "843-475-4392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAROTHERS",
        "first_name": "MICHAEL",
        "middle_name": "B",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-17",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "1922",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA055229",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2059PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolina Spine and Sport Rehabiliatation Specialist,P.a.
• Carolina Teen Center
• Carolina Womens Care PA
• Caroline Speech & Language Center Inc
• Keith A Carothers
• Ryan Matthew Carpenter, DPT
• Taylor Cassidy Carro I
• Erin Nicole Carter, SLP
• Hailey Brooke Carter
• Shanya E Carter, LPC

• Medical Physician Assistant in Summerville, SC
• Providers in Summerville, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.