NPIMap

Organization Active NPI

East Cooper Physician Group LLC

Doing business as High Tide Internal Medicine - East Cooper Medical Group

  • Internal Medicine Physician
  • Daniel Island, SC
National Provider Identifier
1255192308
Registry record updated Feb 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EAST COOPER PHYSICIAN GROUP LLC
Doing business as
High Tide Internal Medicine - East Cooper Medical Group
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
Last updated
Feb 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2026

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

Authorized official

Name
Doreatha Rogers
Title
RCS Manager
Phone
(980) 302-7992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

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 1

  • High Tide Internal Medicine - East Cooper Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 31

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

View all 31

National Provider Directory

National Provider Directory
Tax ID family
East Cooper Physician Group LLC49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Locations

880 Island Park Dr
Unit 220
Daniel Island, SC 29492
Phone (843) 380-9330

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": "1705449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772236800000",
    "number": "1255192308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604408",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 ISLAND PARK DR UNIT 220",
            "city": "DANIEL ISLAND",
            "state": "SC",
            "postal_code": "294922902",
            "telephone_number": "843-380-9330",
            "fax_number": "843-380-8212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST COOPER PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-17",
        "last_updated": "2026-02-28",
        "certification_date": "2026-02-28",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "DOREATHA",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "980-302-7992"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "High Tide Internal Medicine - East Cooper Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Daniel Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2026; 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.