East Cooper Physician Group LLC
Organization Active NPI Internal Medicine Physician · Daniel Island, SC
NPI 1255192308 · NPPES record last updated Feb 28, 2026
Key facts
- NPI
- 1255192308
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- EAST COOPER PHYSICIAN GROUP LLC
- Practice address
- 880 Island Park Dr Unit 220
Daniel Island, SC 29492-2902 - Phone
- (843) 380-9330
- Fax
- (843) 380-8212
- NPI assigned
- Jan 17, 2024
- Organization subpart
- No
Authorized official
- Name
- Doreatha Rogers
- Title
- RCS Manager
- Phone
- (980) 302-7992
Other NPIs on the same Medicare enrollment 31
Corporate family (same tax ID) 48
Practitioners 1
-
Jefferson Tyler Watson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240214000176 | SC | Part B Supplier - Clinic/Group Practice | 1254775687 |
Receives reassigned benefits from 173 practitioners 31 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Goose Creek, SC; Summerville, SC; North Augusta, SC; Mt Pleasant, SC; Mount Pleasant, SC; Beaufort, SC; Georgetown, SC; Fort Mill, SC… |
National Provider Directory
- Tax ID family
- East Cooper Physician Group LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
880 Island Park Dr Unit 220
Daniel Island, SC 29492-2902
Mailing address
PO Box 604408
Charlotte, NC 28260-4408
Other names
- High Tide Internal Medicine - East Cooper Medical Group
Other providers in Daniel Island, SC
- Talicia Durham
- William David Dutton
- Early Eating Specialists
- East Cooper Physician Group LLC
- East Cooper Physician Group LLC
- East Cooper Physician Group LLC
- East Cooper Physician Group LLC
- East Cooper Physician Group LLC
- East Cooper Physician Group LLC
- East Cooper Physician Group LLC
All providers in Daniel Island, SC · Internal Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.