Individual provider Active NPI

Mitchell J Siegan, MD

  • Anesthesiology Physician
  • Charleston, SC
National Provider Identifier
1265486336
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
21770 Issued in SC
Practice address
2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone
(843) 402-1000
NPI assigned
May 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 21770 SC
Anesthesiology Physician 207L00000X 21770 SC Primary

Addresses

Primary practice location

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733

Mailing address

70 Dalton St
Charleston, SC 29492-7959
Phone (843) 402-1000

Other identifiers 1

IdentifierTypeStateIssuer
T59503MedicaidSC

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040602000383 SC Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 3779565023 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours St Francis Xavier Hospital IncGroup PAC ID 8325008717, 202 clinicians

Practice addresses (Care Compare)

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone (843) 402-1436

Hospital & facility affiliations

  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21770SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours St Francis Xavier Hospital, Inc. Current Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. Anesthesiology CurrentSince Jan 1, 2017 Accepting new patients
Anesthesia Associates of Charleston, P.a. Anesthesiology CurrentSince Feb 1, 2019 Accepting new patients
Roper Saint Francis Physicians Network Current Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Jan 1, 2017 Accepting new patients
Coastal Anesthesia Medical Group, LLC Anesthesiology Past Accepting new patients

Locations

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

1064 Gardner Rd
Ste 112
Charleston, SC 29407
Phone (843) 723-3441

8536 Palmetto Commerce Pkwy
Ste 401
Ladson, SC 29456
Phone (843) 203-2260

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1148169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1265486336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 DALTON ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294927959",
            "telephone_number": "843-402-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 HENRY TECKLENBURG DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145733",
            "telephone_number": "843-402-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEGAN",
        "first_name": "MITCHELL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-21",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "SC",
            "license": "21770",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "21770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T59503",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.