NPIMap

Organization Active NPI

Novant Health Southeastern Spine Institute, LLC

Doing business as Southeastern Spine Institute

  • Interventional Pain Medicine Physician
  • Mount Pleasant, SC
National Provider Identifier
1134943459
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
NOVANT HEALTH SOUTHEASTERN SPINE INSTITUTE, LLC
Doing business as
Southeastern Spine Institute
Practice address
1625 Hospital Dr
Mt Pleasant, SC 29464-3698
Phone
(843) 849-1551
Fax
(843) 884-0629
NPI assigned
Nov 13, 2024
Last updated
Apr 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Authorized official

Name
Leea Walton
Title
RCS Manager
Phone
(336) 515-7085

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X
Orthopaedic Surgery of the Spine Physician 207XS0117X
Physical Medicine & Rehabilitation Physician 208100000X
Interventional Pain Medicine Physician 208VP0014X Primary

Addresses

Primary practice location

1625 Hospital Dr
Mt Pleasant, SC 29464-3698

Mailing address

2085 Frontis Plaza Blvd
Winston Salem, NC 27103-5614

Other practice location 1

1748 Saint Matthews Rd
Orangeburg, SC 29118-2441
Phone (843) 849-1551

Other practice location 2

12015 Highway 707
Murrells Inlet, SC 29576-9737
Phone (843) 849-1551

Other practice location 3

1014 Saint Andrews Blvd
Charleston, SC 29407-7139
Phone (843) 849-1551

Other names 1

  • Southeastern Spine Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250218000234 SC Part B Supplier - Clinic/Group Practice 0244750578 Receives reassigned benefits from 35 practitioners
Practice locations: Charleston, SC; Mt Pleasant, SC; Murrells Inlet, SC; Orangeburg, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1731456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775433600000",
    "number": "1134943459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 FRONTIS PLAZA BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 HOSPITAL DR",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643698",
            "telephone_number": "843-849-1551",
            "fax_number": "843-884-0629"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1748 Saint Matthews Rd",
            "address_purpose": "LOCATION",
            "city": "Orangeburg",
            "state": "SC",
            "postal_code": "291182441",
            "country_code": "US",
            "telephone_number": "843-849-1551",
            "fax_number": "849-278-6052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12015 Highway 707",
            "address_purpose": "LOCATION",
            "city": "Murrells Inlet",
            "state": "SC",
            "postal_code": "295769737",
            "country_code": "US",
            "telephone_number": "843-849-1551",
            "fax_number": "843-278-6052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1014 Saint Andrews Blvd",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294077139",
            "country_code": "US",
            "telephone_number": "843-849-1551",
            "fax_number": "843-278-6052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH SOUTHEASTERN SPINE INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-13",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "336-515-7085"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Spine Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeastern Spine Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.