NPIMap

Organization Active NPI

Roper Hospital Inc.

Doing business as Vascular Medicine and Wound Management Clinic

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • N Charleston, SC
National Provider Identifier
1104563758
Registry record updated Mar 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
Legal business name
ROPER HOSPITAL INC.
Doing business as
Vascular Medicine and Wound Management Clinic
Practice address
8950 University Blvd
Ste 300
N. Charleston, SC 29406-9889
Phone
(843) 724-2289
Fax
(843) 606-8038
NPI assigned
May 16, 2022
Last updated
Mar 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2024

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

Authorized official

Name
Kimberly M Ralston
Title
Director
Phone
(419) 996-5119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083P0011X Primary

Addresses

Primary practice location

8950 University Blvd
Ste 300
N. Charleston, SC 29406-9889

Mailing address

PO Box 751649
Charlotte, NC 28275-1649
Phone (888) 472-0043

Other names 1

  • Vascular Medicine and Wound Management Clinic Doing business as

Electronic endpoints 1

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

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
This NPI is an additional NPI on the enrollment
Practice locations: Walterboro, SC; N Charleston, SC; Mt Pleasant, SC; Moncks Corner, SC; Goose Creek, SC; Charleston, SC

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
Tax ID family
Roper Mount Pleasant in26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

125 Doughty St
Ste 440
Charleston, SC 29403
Phone (843) 958-8877

125 Doughty St
Ste 695
Charleston, SC 29403
Phone (843) 720-8495

125 Doughty St
Ste 700
Charleston, SC 29403
Phone (843) 577-6251

1483 Tobias Gadson Blvd
Ste 208A
Charleston, SC 29407
Phone (843) 402-7000

16 Farmfield Ave
Ste E
Charleston, SC 29407

2095 Henry Tecklenburg Dr
#201W
Charleston, SC 29414
Phone (843) 402-1067

2145 Henry Tecklenburg Dr
Ste 120
Charleston, SC 29414
Phone (843) 720-4738

233 Calhoun St
Charleston, SC 29401
Phone (803) 723-0357

316 Calhoun St
Rm 2324
Charleston, SC 29401
Phone (843) 720-8424

325 Folly Rd
Ste 108
Charleston, SC 29412
Phone (843) 789-1726

345 Freshfields Dr
Ste J
Johns Island, SC 29455
Phone (843) 768-4800

730 Stony Landing Rd
Ste 103
Moncks Corner, SC 29461

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

1341 Old Georgetown Rd
Ste A
Mt Pleasant, SC 29464
Phone (843) 856-5722

180 Wingo Way
Ste 105
Mt Pleasant, SC 29464
Phone (843) 284-0818

676 Wando Park Blvd
Mt Pleasant, SC 29464
Phone (843) 529-3100

2233 Northwoods Blvd
North Charleston, SC 29406
Phone (843) 773-9903

7832 Rivers Ave
North Charleston, SC 29406
Phone (843) 824-8733

Practitioners & affiliated clinicians

Practitioners 271

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 271

NPI Registry JSON

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

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710633600000",
    "number": "1104563758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751649",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751649",
            "telephone_number": "888-472-0043",
            "fax_number": "843-724-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8950 UNIVERSITY BLVD",
            "address_2": "STE 300",
            "city": "N. CHARLESTON",
            "state": "SC",
            "postal_code": "294069889",
            "telephone_number": "843-724-2289",
            "fax_number": "843-606-8038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROPER HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-16",
        "last_updated": "2024-03-17",
        "certification_date": "2024-03-17",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-996-5119"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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",
            "affiliationName": "Cobius Healthcare Solutions",
            "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": "Vascular Medicine and Wound Management Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vascular Medicine and Wound Management Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in N Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2024; 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.