NPIMap

Organization Active NPI

Sungate Dermatology

  • Dermatopathology Physician
  • Bluffton, SC
National Provider Identifier
1245675636
Registry record updated Apr 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
MD31744 Issued in SC
Legal business name
SUNGATE DERMATOLOGY
Practice address
10 William Pope Dr
Sungate Medical Center, Suite #4
Bluffton, SC 29909-7549
Phone
(843) 705-1513
Fax
(843) 705-1514
NPI assigned
Apr 30, 2013
Organization subpart
Yes
Parent organization
PALMETTO EYE SPECIALISTS PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 30, 2013

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

Authorized official

Name
Dr. Kenneth Daniel Farr, M.D.
Title
Medical Director
Phone
(843) 842-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X MD31744 SC Primary

Addresses

Primary practice location

10 William Pope Dr
Sungate Medical Center, Suite #4
Bluffton, SC 29909-7549

Mailing address

10 William Pope Dr
Sungate Medical Center, Suite #4
Bluffton, SC 29909-7549
Phone (843) 705-1513

Other identifiers 4

IdentifierTypeStateIssuer
6830OtherSCMEDICARE
CH3121OtherSCRAILROAD MEDICARE
GP2666MedicaidSC
P00764908OtherSCMEDICARE GROUP PTAN

National Provider Directory

National Provider Directory
Tax ID family
Sungate Dermatology3 organizations share this tax ID, including this one
Part of
Sungate Dermatology

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367280000000",
    "number": "1245675636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WILLIAM POPE DR",
            "address_2": "SUNGATE MEDICAL CENTER, SUITE #4",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299097549",
            "telephone_number": "843-705-1513",
            "fax_number": "843-705-1514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WILLIAM POPE DR",
            "address_2": "SUNGATE MEDICAL CENTER, SUITE #4",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299097549",
            "telephone_number": "843-705-1513",
            "fax_number": "843-705-1514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNGATE DERMATOLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALMETTO EYE SPECIALISTS PA",
        "enumeration_date": "2013-04-30",
        "last_updated": "2013-04-30",
        "status": "A",
        "authorized_official_last_name": "FARR",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "843-842-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "SC",
            "license": "MD31744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "6830",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH3121",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2666",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "P00764908",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bluffton, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.