NPIMap

Individual provider Active NPI

Karen Boulanger Pack, PA

  • Physician Assistant
  • Charleston, SC
National Provider Identifier
1184653610
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
668 Issued in SC
Practice address
3424 Shelby Ray CT
Charleston, SC 29414-5838
Phone
(843) 402-6834
Fax
(843) 573-9963
NPI assigned
Jun 30, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 668 SC Primary

Addresses

Primary practice location

3424 Shelby Ray CT
Charleston, SC 29414-5838

Mailing address

4416 Forest Dr
2ND Floor
Columbia, SC 29206-3104
Phone (803) 782-4278

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, AZ2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20080619000557 NC Practitioner - Physician Assistant 5799856647 Reassigns benefits to 6 organizations
I20150515002259 AZ Practitioner - Physician Assistant 5799856647 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.66 of 100Reported as group
Quality
86.13
Improvement activities
40
Cost
79.44

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
668SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cfvhs Ed Physicians CurrentSince Sep 25, 2025 Accepting new patients
North Carolina Em-1 Medical Services, PC Physician Assistant CurrentSince Mar 1, 2009 Accepting new patients
Vidant Medical Group LLC CurrentSince Jun 12, 2023 Accepting new patients
Cfvhs Ed Physicians CurrentSince Sep 25, 2025 Accepting new patients
Outer Banks Professional Services, LLC CurrentSince Apr 2, 2024 Accepting new patients
Progressive Physical Therapy, P.a. PastSince Sep 4, 2023 Accepting new patients
Charleston Emergency Services LLC Past Accepting new patients
Progressive Phyiscal Therapy, PA Past Accepting new patients
Golden Grove Emergency Physicians Past Accepting new patients
Pack Family Medicine, PLLC Physician Assistant PastSince May 3, 2010 Accepting new patients

Locations

501 S Poplar St
Elizabethtown, NC 28337
Phone (910) 862-4043

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

210 Medical Pavilion Dr
Raeford, NC 28376
Phone (910) 904-8000

5565 N Croatan Hwy
Southrn Shore, NC 27949
Phone (252) 261-5800

Interoperability endpoints

  • Direct secure messaging: kpack121203@capefearvalley.direct-ci.com

Organizations & group practices 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184653610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4416 FOREST DR",
            "address_2": "2ND FLOOR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292063104",
            "telephone_number": "803-782-4278",
            "fax_number": "803-782-3445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3424 SHELBY RAY CT",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145838",
            "telephone_number": "843-402-6834",
            "fax_number": "843-573-9963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "KAREN",
        "middle_name": "BOULANGER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.