NPIMap

Organization Active NPI

PPCP Specialty Physicians , LLC

  • Gastroenterology Physician
  • Charleston, SC
National Provider Identifier
1154886471
Registry record updated Feb 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
PPCP SPECIALTY PHYSICIANS , LLC
Practice address
3030 Ashley Town Center Dr Ste 102a
Charleston, SC 29414-5678
Phone
(843) 258-4994
Fax
(843) 507-8623
NPI assigned
Feb 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2022

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

Authorized official

Name
Terry Cunningham
Title
Ceo
Phone
(843) 695-6071

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

3030 Ashley Town Center Dr Ste 102a
Charleston, SC 29414-5678

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
GP8921MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170801001865 SC Part B Supplier - Clinic/Group Practice 2466723028 Receives reassigned benefits from 32 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charleston, SC; Summerville, SC; Mt Pleasant, SC; Moncks Corner, SC; Ladson, SC; Irmo, SC; Goose Creek, SC; Daniel Island, SC…

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
PPCP Specialty Physicians LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1548979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646006400000",
    "number": "1154886471",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 ASHLEY TOWN CENTER DR STE 102A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145678",
            "telephone_number": "843-258-4994",
            "fax_number": "843-507-8623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPCP SPECIALTY PHYSICIANS , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-01",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-695-6071"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8921",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Feb 28, 2022; 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.