NPIMap

Individual provider Active NPI

Rachel L. King, PA

  • Physician Assistant
  • Goose Creek, SC
National Provider Identifier
1154924066
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4563 Issued in SC
Practice address
119 Springhall Dr
Goose Creek, SC 29445-5368
Phone
(432) 662-5208
Fax
(843) 553-4436
NPI assigned
Nov 21, 2020
Last updated
Sep 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MO
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 4563 SC Primary

Addresses

Primary practice location

119 Springhall Dr
Goose Creek, SC 29445-5368

Mailing address

119 Springhall Dr
Goose Creek, SC 29445-5368
Phone (843) 266-2520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, SC, IL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20211026000996 MO Practitioner - Physician Assistant 0547658411 Reassigns benefits to 1 organization
I20221018001593 SC Practitioner - Physician Assistant 0547658411 Reassigns benefits to 1 organization
I20241205004191 IL Practitioner - Physician Assistant 0547658411 Reassigns benefits to 9 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

2524 N Illinois St
Swansea, IL 62226-2353
Phone (618) 212-3144

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4563SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Total Access Urgent Care, PC CurrentSince Nov 4, 2024 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Oct 7, 2022 Accepting new patients
Total Access Urgent Care, PC CurrentSince Nov 4, 2024 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Oct 7, 2022 Accepting new patients

Locations

1103 Central Park Dr
O Fallon, IL 62269
Phone (618) 215-5703

9556 Manchester Rd
Saint Louis, MO 63119
Phone (314) 373-5740

1717 Madison Ave
Washington, MO 63090
Phone (636) 244-6950

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

119 Springhall Dr
Goose Creek, SC 29445
Phone (843) 266-2520

110 Springhall Dr
Ste A
Goose Creek, SC 29445
Phone (843) 973-8503

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1605916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1154924066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 SPRINGHALL DR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294455368",
            "telephone_number": "843-266-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SPRINGHALL DR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294455368",
            "telephone_number": "432-662-5208",
            "fax_number": "843-553-4436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "RACHEL",
        "middle_name": "L.",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-21",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goose Creek, SC

Sources for this page

Verify at the official NPI Registry.