NPIMap

Organization Active NPI

Roper Hospital, Inc.

Doing business as The Ryan White Wellness Center

  • Infectious Disease Physician
  • Charleston, SC
National Provider Identifier
1104150739
Registry record updated Apr 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
ROPER HOSPITAL, INC.
Doing business as
The Ryan White Wellness Center
Practice address
1481 Tobias Gadson Blvd
Suite 1
Charleston, SC 29407-4794
Phone
(843) 402-3093
Fax
(843) 402-3094
NPI assigned
Sep 30, 2009
Last updated
Apr 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2026

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

Authorized official

Name
Mrs. Rebecca Tucker
Title
Cfo
Phone
(843) 203-2265

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X SC
Infectious Disease Physician 207RI0200X SC Primary

Addresses

Primary practice location

1481 Tobias Gadson Blvd
Suite 1
Charleston, SC 29407-4794

Mailing address

PO Box 632500
Cincinnati, OH 45263-2500
Phone (888) 472-0043

Other practice location 1

730 Stony Landing Rd Ste 104
Moncks Corner, SC 29461-2904
Phone (843) 402-3093

Other identifiers 3

IdentifierTypeStateIssuer
088/093OtherSCTRICARE SUFFIX
GP5274MedicaidSC
083OtherSCBCBS SC AND BLUECHOICE SUFIX

Other names 1

  • The Ryan White Wellness Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041228000500 SC Part B Supplier - Clinic/Group Practice 8426958919 Receives reassigned benefits from 156 practitioners
17 other NPIs on this enrollment
Practice locations: Walterboro, SC; N Charleston, SC; Mt Pleasant, SC; Moncks Corner, SC; Goose Creek, SC; Charleston, SC

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 156

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 156

NPI Registry JSON

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

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775952000000",
    "number": "1104150739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632500",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632500",
            "telephone_number": "888-472-0043",
            "fax_number": "513-653-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1481 TOBIAS GADSON BLVD",
            "address_2": "SUITE 1",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074794",
            "telephone_number": "843-402-3093",
            "fax_number": "843-402-3094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "730 Stony Landing Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Moncks Corner",
            "state": "SC",
            "postal_code": "294612904",
            "country_code": "US",
            "telephone_number": "843-402-3093",
            "fax_number": "843-606-8078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ROPER HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-30",
        "last_updated": "2026-04-12",
        "certification_date": "2026-04-12",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "843-203-2265",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE SUFFIX",
            "identifier": "088/093",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5274",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS SC AND BLUECHOICE SUFIX",
            "identifier": "083",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Ryan White Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.