Individual provider Active NPI

Brooke Elizabeth Watson, PA-C

  • Physician Assistant
  • Summerville, SC
National Provider Identifier
1114402153
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5500 Front St Ste 260
Summerville, SC 29486-8140
Phone
(843) 576-0700
Fax
(843) 576-0701
NPI assigned
Sep 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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 Primary

Addresses

Primary practice location

5500 Front St Ste 260
Summerville, SC 29486-8140

Mailing address

PO Box 530062
Atlanta, GA 30353-0062
Phone (843) 695-6071

Other identifiers 1

IdentifierTypeStateIssuer
3386PAMedicaidSC

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
I20190208002136 SC Practitioner - Physician Assistant 9234477696 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
PPCP Specialty Physicians , LLCGroup PAC ID 2466723028, 20 clinicians

Practice addresses (Care Compare)

5500 Front St
Suite 260
Summerville, SC 29486-7735
Phone (843) 376-0670

7 S Alliance Dr
Suite 202a
Goose Creek, SC 29445-7269
Phone (843) 376-0670

Hospital & facility affiliations

  • Trident Medical Center Hospital, Charleston, SC, CCN 420079
  • Roper St Francis Hospital-Berkeley Inc Hospital, Summerville, SC, CCN 420110

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
PPCP Specialty Physicians , LLC CurrentSince Jul 11, 2022 Accepting new patients
PPCP Specialty Physicians, LLC CurrentSince Jul 11, 2022 Accepting new patients
PPCP Specialty Physicians , LLC Past Accepting new patients
PPCP Specialty Physicians, LLC Past Accepting new patients

Locations

7 S Alliance Dr
Ste 202A
Goose Creek, SC 29445
Phone (843) 376-6070

5500 Front St
Ste 260
Summerville, SC 29486

Interoperability endpoints

  • Direct secure messaging: brooke.watson@ppcp1.eclinicaldirectplus.com

Organizations & group practices 4

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 2

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": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1114402153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530062",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303530062",
            "telephone_number": "843-695-6071",
            "fax_number": "843-569-5881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 FRONT ST STE 260",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294868140",
            "telephone_number": "843-576-0700",
            "fax_number": "843-576-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "BROOKE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-25",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3386PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

Verify at the official NPI Registry.