Individual provider Active NPI

Christopher C Stephanoff, PA

  • Medical Physician Assistant
  • North Charleston, SC
National Provider Identifier
1265442891
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
A341HEM Issued in SC
Practice address
2910 Tricom St
North Charleston, SC 29406-9350
Phone
(843) 572-9211
Fax
(843) 572-0457
NPI assigned
Aug 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X A341HEM SC Primary

Addresses

Primary practice location

2910 Tricom St
North Charleston, SC 29406-9350

Mailing address

2910 Tricom St
North Charleston, SC 29406-9350
Phone (843) 572-9211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040309000980 SC Practitioner - Physician Assistant 8820986946 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
341SCMDPsychologist
A341HEMSCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours St Francis Xavier Hospital, Inc. CurrentSince Jan 1, 2012 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Jan 1, 2012 Accepting new patients
Roper St. Francis Mount Pleasant Hospital CurrentSince Feb 13, 2021 Accepting new patients
Roper Hospital Inc CurrentSince Oct 1, 2003 Accepting new patients
Roper Hospital Inc. CurrentSince Oct 1, 2003 Accepting new patients

Locations

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

730 Stony Landing Rd
Moncks Corner, SC 29461
Phone (843) 572-9211

3500 N Highway 17
Mt Pleasant, SC 29466
Phone (843) 606-7000

2910 Tricom St
North Charleston, SC 29406
Phone (843) 572-9211

7832 Rivers Ave
North Charleston, SC 29406
Phone (843) 824-8733

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265442891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069350",
            "telephone_number": "843-572-9211",
            "fax_number": "843-572-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069350",
            "telephone_number": "843-572-9211",
            "fax_number": "843-572-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHANOFF",
        "first_name": "CHRISTOPHER",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "A341HEM",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

Verify at the official NPI Registry.