Organization Active NPI

John C. Macilwaine, M.D., LLC

  • Orthopaedic Hand Surgery Physician
  • Charleston, SC
National Provider Identifier
1194853168
Registry record updated Aug 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
29539 Issued in SC
Legal business name
JOHN C. MACILWAINE, M.D., LLC
Practice address
125 Doughty St
Suite 280
Charleston, SC 29403-5736
Phone
(843) 769-9450
Fax
(843) 769-9451
NPI assigned
Mar 1, 2007
Last updated
Aug 19, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2013

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

Authorized official

Name
John C. Macilwaine, M.D.NPI 1962496802
Title
Physician
Phone
(843) 769-9450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery Physician 207XS0106X 29539 SC Primary

Addresses

Primary practice location

125 Doughty St
Suite 280
Charleston, SC 29403-5736

Mailing address

125 Doughty St
Suite 280
Charleston, SC 29403-5736
Phone (843) 769-9450

Other identifiers 1

IdentifierTypeStateIssuer
295399MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070613000773 SC Part B Supplier - Clinic/Group Practice 5597863696 Receives reassigned benefits from 1 practitioner
Practice locations: Charleston, SC; Mount Pleasant, SC

National Provider Directory

National Provider Directory

Locations

2097 Henry Tecklenburg Dr
Ste 218
Charleston, SC 29414
Phone (843) 571-6868

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": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376870400000",
    "number": "1194853168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 DOUGHTY ST",
            "address_2": "SUITE 280",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035736",
            "telephone_number": "843-769-9450",
            "fax_number": "843-769-9451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 DOUGHTY ST",
            "address_2": "SUITE 280",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035736",
            "telephone_number": "843-769-9450",
            "fax_number": "843-769-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN C. MACILWAINE, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2013-08-19",
        "status": "A",
        "authorized_official_last_name": "MACILWAINE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "843-769-9450",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "SC",
            "license": "29539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "295399",
            "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 Aug 19, 2013; 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.