NPIMap

Organization Active NPI

Medical University of SC

  • Oral and Maxillofacial Pathology Dentistry
  • Charleston, SC
National Provider Identifier
1194026153
Registry record updated Mar 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
Legal business name
MEDICAL UNIVERSITY OF SC
Practice address
173 Ashley Ave
Charleston, SC 29425-8908
Phone
(843) 792-4495
Fax
(843) 792-3697
NPI assigned
Nov 8, 2010
Last updated
Mar 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2020

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

Authorized official

Name
Dr. Brad W. Neville, DDSNPI 1275614828
Title
Director of Division of Oral Pathol
Phone
(843) 792-4496

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0106X Primary

Addresses

Primary practice location

173 Ashley Ave
Charleston, SC 29425-8908

Mailing address

MSC 507 173 Ashley Avenue
Charleston, SC 29425-0001
Phone (843) 792-4495

Other identifiers 2

IdentifierTypeStateIssuer
ZX0019MedicaidSC
2375MedicaidSC

Other names 1

  • Division of Oral Pathology Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL N/A Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120316000104 SC Part B Supplier - Independent Clinical Laboratory 2365403698 Practice locations: Charleston, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Muscdental Faculty Practice13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Musc Medical CenterCharleston, SC, CCN 420004 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Aug 1, 2001
Mar 1, 2019
Musc Health Marion Medical CenterMullins, SC, CCN 42U055 Hospital Operational/Managerial Control Mar 1, 2019
Musc Health Florence Medical CenterFlorence, SC, CCN 420091 Hospital Operational/Managerial Control Mar 1, 2019
Musc Health Marion Medical CenterMullins, SC, CCN 420055 Hospital Operational/Managerial Control Mar 1, 2019
Kershaw Medical CenterCamden, SC, CCN 420048 Hospital Operational/Managerial Control Mar 1, 2019
Columbia Medical Center DowntownColumbia, SC, CCN 420026 Hospital Operational/Managerial Control Mar 1, 2019
Musc Health Black River Medical CenterCades, SC, CCN 420117 Hospital Operational/Managerial Control Mar 1, 2019
Musc Health Mullins Nursing HomeMullins, SC, CCN 425312 Skilled nursing facility 5% Or Greater Direct Ownership Interest Mar 1, 2019
Musc Health Chester Nursing CenterChester, SC, CCN 425061 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Musc Health Hospice KershawLugoff, SC, CCN 421519 Hospice 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2021

Owned or controlled facilities with NPI records 19

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 19

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1194026153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MSC 507 173 ASHLEY AVENUE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294250001",
            "telephone_number": "843-792-4495",
            "fax_number": "843-792-3697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258908",
            "telephone_number": "843-792-4495",
            "fax_number": "843-792-3697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL UNIVERSITY OF SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-08",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "NEVILLE",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "DIRECTOR OF DIVISION OF ORAL PATHOL",
        "authorized_official_telephone_number": "843-792-4496",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX0019",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2375",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "endpointDescription": "N/A",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "N/A",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "N/A",
            "address_1": "173 Ashley Ave",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294258908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Division of Oral Pathology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Division of Oral Pathology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.