NPIMap

Organization Active NPI

Centerwell Senior Primary Care (SC) PC

  • Internal Medicine Physician
  • North Charleston, SC
National Provider Identifier
1235699240
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE (SC) PC
Practice address
1213 Remount Rd
North Charleston, SC 29406-3433
Phone
(843) 973-5415
Fax
(833) 994-1101
NPI assigned
Mar 25, 2019
Organization subpart
Yes
Parent organization
CENTERWELL SENIOR PRIMARY CARE (SC) PCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Other NPIs on the same Medicare enrollment 8

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

Corporate family (same tax ID) 4

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

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2174404Centerwell Senior Primary Care - North Charleston1213 Remount Road, N Charleston, SC 29406Certificate of waiverOct 30, 2027

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20201216002926 SC Part B Supplier - Clinic/Group Practice 2860804796 Receives reassigned benefits from 85 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, SC; Spartanburg, SC; Seneca, SC; North Charleston, SC; Greer, SC; Charleston, SC; Anderson, SC

National Provider Directory

National Provider Directory
Tax ID family
Centerwell Senior Primary Care NC PC (5 organizations share this tax ID)
Part of
Centerwell Senior Primary Care NC PC

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

NPPES NPI Registry

Primary practice location

1213 Remount Rd
North Charleston, SC 29406-3433

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
GP9109MedicaidSC

Other names 4

NPPES NPI Registry
  • CenterWell Senior Primary Care-North Charleston Doing business as
  • Partners in Primary Care, North Charleston Doing business as
  • Partners in Primary Care NC PC Former legal business name
  • Partners in Primary Care SC PC Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 19, 2024.

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1235699240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 REMOUNT RD",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294063433",
            "telephone_number": "843-973-5415",
            "fax_number": "833-994-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE (SC) PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE (SC) PC",
        "enumeration_date": "2019-03-25",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP9109",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care-North Charleston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care, North Charleston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care, North Charleston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care NC PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Partners in Primary Care SC PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in North 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, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.