Kenneth Carl Staples Jr., D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

82113 Issued in SC

Practice address

2829 E Highway 76
Mullins, SC 29574-6035

Phone

(843) 431-2000

NPI assigned

Feb 18, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Merit-based Incentive Payment System (MIPS)

Final score

80.41 of 100Reported as group

Quality

64.93

Promoting interoperability

99

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kstaples275966@direct.musc.edu

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.

• App of South Carolina Ed PLLC

  • Emergency Medicine Physician
  • Hartsville, SC
  • NPI 1457878084
  Medicare reassignment NPD
• Carolina Family Care, Inc

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1184655722
  Medicare reassignment NPD
• Musc Community Physicians

  • Internal Medicine Physician
  • Bamberg, SC
  • NPI 1841878006

  Emergency Medicine

  Medicare reassignment NPD
• Life Link Ambulance Service

  • Land Ambulance
  • Mullins, SC
  • NPI 1497597173
  NPD Authorized official
• Maverick Medical Transport LLC

  • Land Ambulance
  • Mullins, SC
  • NPI 1144058934
  NPD Authorized official
• Carolina Family Care, Inc

  • Internal Medicine Physician
  • Lancaster, SC
  • NPI 1275564098

  Emergency Medicine

  NPD
• Musc Community Physicians

  • Rural Health Clinic/Center
  • Bowman, SC
  • NPI 1225735772
  NPD
• Musc Community Physicians

  • Family Medicine Physician
  • Bamberg, SC
  • NPI 1992383145
  NPD

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

{
    "created_epoch": "1424217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1265824809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603898",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603898",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 E HIGHWAY 76",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295746035",
            "telephone_number": "843-431-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5100 W Broad St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432281607",
            "country_code": "US",
            "telephone_number": "614-544-1000",
            "fax_number": "614-544-1751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAPLES",
        "first_name": "KENNETH",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-18",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "82113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Benjamin Snipes, DMD
• South Carolina CVS Pharmacy LLC
• South Carolina Podiatric Physicians and Surgeons Group, LLC
• Daniel Jason Spivey
• Springlake Medical Transport, LLC
• State of South Carolina
• Bobby Tanner
• Deidre Ann Tarte
• Chadwick V. Thomas, M.D.
• Erica Rabon Thompkins, RN, FNP STUDENT

• Emergency Medicine Physician in Mullins, SC
• Providers in Mullins, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.