Individual provider Active NPI

Mahnoor Mushtaq

  • Physician Assistant
  • Florence, SC
National Provider Identifier
1073361465
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
555 E Cheves St
Florence, SC 29506-2617
Phone
(843) 777-2000
NPI assigned
May 9, 2024
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 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 NU Primary

Addresses

Primary practice location

555 E Cheves St
Florence, SC 29506-2617

Mailing address

555 E Cheves St
Florence, SC 29506-2617

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250428000786 SC Practitioner - Physician Assistant 2264958859 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLeod Physician Associates IIGroup PAC ID 8224031307, 541 clinicians

Practice addresses (Care Compare)

101 William H Johnson St
Suite 600
Florence, SC 29506-2773
Phone (843) 667-1891

540 Physicians LN
Sumter, SC 29150-3370
Phone (803) 883-5171

555 E Cheves St
Florence, SC 29506-2617
Phone (843) 777-2000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince Apr 21, 2025 Accepting new patients
McLeod Physician Associates II CurrentSince Feb 5, 2026 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince Apr 21, 2025 Accepting new patients
McLeod Physician Associates II CurrentSince Feb 5, 2026 Accepting new patients
McLeod Physician Associates II Past Accepting new patients

Locations

101 William H Johnson St
Ste 600
Florence, SC 29506
Phone (843) 667-1891

506 E Cheves St
#202
Florence, SC 29506

555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233

540 Physicians Ln
Sumter, SC 29150
Phone (803) 778-1941

Interoperability endpoints

  • Direct secure messaging: mmushtaq22967@directmcleodehealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1715212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1073361465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 E CHEVES ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E CHEVES ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062617",
            "telephone_number": "843-777-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSHTAQ",
        "first_name": "MAHNOOR",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-09",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.