NPIMap

Individual provider Active NPI

Justin Daniel Ellett, MD, PHD

  • Urology Physician
  • N Charleston, SC
National Provider Identifier
1275827248
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
33598 Issued in SC
Practice address
2687 Lake Park Drive
N Charleston, SC 29406
Phone
(843) 572-1010
Fax
(843) 569-1719
NPI assigned
Jun 7, 2011
Last updated
Feb 17, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2017

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 33598 SC Primary

Addresses

Primary practice location

2687 Lake Park Drive
N Charleston, SC 29406

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
335989MedicaidSC
1275827248OtherSCMEDCOST

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
I20160620001115 SC Practitioner - Urology 8527357318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Medical University of South Carolina College of Medicine, 2011
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)

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

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 resection1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lowcountry Urology Clinics, PA Urology CurrentSince Jul 1, 2016 Accepting new patients
Lowcountry Urology Clinics PA Urology CurrentSince Jul 1, 2016 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

Interoperability endpoints

  • Direct secure messaging: jellett@lcuc.gwaydirect.com

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 10

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": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1275827248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "641 SAINT ANDREWS BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077165",
            "telephone_number": "843-766-4070",
            "fax_number": "843-766-0633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2687 LAKE PARK DRIVE",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "29406",
            "telephone_number": "843-572-1010",
            "fax_number": "843-569-1719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLETT",
        "first_name": "JUSTIN",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-07",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SC",
            "license": "33598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "335989",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "1275827248",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in N Charleston, SC

Sources for this page

Verify at the official NPI Registry.