NPIMap

Individual provider Active NPI

Ian Y Marshall, M. D.

  • Urology Physician
  • Charleston, SC
National Provider Identifier
1255384053
Registry record updated Mar 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
14936 Issued in SC
Practice address
641 Saint Andrews Blvd
Charleston, SC 29407-7165
Phone
(843) 766-9747
Fax
(843) 766-3399
NPI assigned
May 19, 2006
Last updated
Mar 14, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 14936 SC Primary

Addresses

Primary practice location

641 Saint Andrews Blvd
Charleston, SC 29407-7165

Mailing address

2687 Lake Park Dr
N Charleston, SC 29406-9100
Phone (843) 572-0097

Other identifiers 1

IdentifierTypeStateIssuer
GP4437MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041006000035 SC Practitioner - Urology 9739148719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Medical University of South Carolina College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lowcountry Urology Clinics, PAGroup PAC ID 6406869247, 14 clinicians

Practice addresses (Care Compare)

1470 Tobias Gadson Blvd
Charleston, SC 29407-4707
Phone (843) 556-7060

2687 Lake Park Dr
North Charleston, SC 29406-9100
Phone (843) 572-1010

641 Saint Andrews Blvd
Charleston, SC 29407-7165
Phone (843) 766-4070

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lowcountry Urology Clinics, PA Urology CurrentSince Aug 7, 2006 Accepting new patients
Lowcountry Urology Clinics PA Urology CurrentSince Aug 7, 2006 Accepting new patients
Lowcountry Urology Clinics, PA Past Accepting new patients

Locations

641 Saint Andrews Blvd
Charleston, SC 29407
Phone (843) 577-6015

2687 Lake Park Dr
North Charleston, SC 29406
Phone (843) 572-0097

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363219200000",
    "number": "1255384053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2687 LAKE PARK DR",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294069100",
            "telephone_number": "843-572-0097",
            "fax_number": "843-725-3118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 SAINT ANDREWS BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077165",
            "telephone_number": "843-766-9747",
            "fax_number": "843-766-3399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "IAN",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2013-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SC",
            "license": "14936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4437",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.