Individual provider Active NPI

Kerry Shults

  • Physical Therapist
  • Summerville, SC
National Provider Identifier
1154029163
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
330 E 5TH North St Ste D&E
Summerville, SC 29483-0702
Phone
(843) 695-0326
Fax
(843) 695-0328
NPI assigned
Feb 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X SC Primary

Addresses

Primary practice location

330 E 5TH North St Ste D&E
Summerville, SC 29483-0702

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (866) 370-8206

Other practice location 1

819 Brookfield Dr
Seven Fields, PA 16046-4203
Phone (724) 814-0568

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241023003106 SC Practitioner - Physical Therapist in Private Practice 3072986249 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greenville Proaxis Therapy LLCGroup PAC ID 0244267771, 221 clinicians

Practice addresses (Care Compare)

203 E Butler Rd
Suite C
Mauldin, SC 29662-2105
Phone (864) 268-6686

Merit-based Incentive Payment System (MIPS)

Final score
86.09 of 100Reported as group
Quality
89.13
Improvement activities
40
Cost
73.57

Merit-based Incentive Payment System (MIPS)

Final score
86.49 of 100Reported as group
Quality
89.43
Improvement activities
40
Cost
74.33

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
RSFH - Ati Physical Therapy, LLC Physical Therapist CurrentSince Jul 8, 2024 Accepting new patients
RSFH - Ati Physical Therapy, LLC Physical Therapist CurrentSince Jul 8, 2024 Accepting new patients
Greenville Proaxis Therapy LLC CurrentSince Jan 1, 2025 Accepting new patients
Greenville Proaxis Therapy, LLC Physical Therapist CurrentSince Jan 1, 2025 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33205 Collection Ctr Dr
Chicago, IL 60693

33299 Collection Ctr Dr
Chicago, IL 60693

103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753

200 Patewood Dr
Ste C150
Greenville, SC 29615
Phone (864) 454-0904

203 E Butler Rd
#C
Mauldin, SC 29662
Phone (864) 268-6686

180 Wingo Way
Ste 303
Mt Pleasant, SC 29464
Phone (843) 972-0940

910 Johnnie Dodds Blvd
Ste 140
Mt Pleasant, SC 29464
Phone (843) 972-0940

9241 University Blvd
Ste B1
North Charleston, SC 29406
Phone (843) 414-1140

2615 Woodruff Rd
Ste 400
Simpsonville, SC 29681
Phone (864) 537-5016

330 E 5th North St
Ste De
Summerville, SC 29483
Phone (843) 695-0326

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.

NPI Registry JSON

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

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1154029163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "866-370-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E 5TH NORTH ST STE D&E",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294830702",
            "telephone_number": "843-695-0326",
            "fax_number": "843-695-0328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "819 Brookfield Dr",
            "address_purpose": "LOCATION",
            "city": "Seven Fields",
            "state": "PA",
            "postal_code": "160464203",
            "country_code": "US",
            "telephone_number": "724-814-0568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHULTS",
        "first_name": "KERRY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.