NPIMap

Organization Active NPI

Musc Community Physicians

Doing business as MUSC Health Primary Care - Carolina Ave

  • Rural Health Clinic/Center
  • Orangeburg, SC
National Provider Identifier
1285330688
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MUSC COMMUNITY PHYSICIANS
Doing business as
MUSC Health Primary Care - Carolina Ave
Practice address
1619 Carolina Ave Ste 215
Orangeburg, SC 29115-4939
Phone
(843) 792-1414
NPI assigned
Feb 7, 2023
Last updated
Feb 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
Karyn Rae
Title
Chief, Payor Relations
Phone
(843) 876-1344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1619 Carolina Ave Ste 215
Orangeburg, SC 29115-4939

Mailing address

PO Box 23321
New York, NY 10087-3321
Phone (843) 792-6200

Other names 1

  • MUSC Health Primary Care - Carolina Ave Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230406002787 SC Part A Provider - Rural Health Clinic 6507260668 Practice locations: Orangeburg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285330688. Details of each certification follow.

Rural health clinic certification: CCN 423883

Legal name
MUSC COMMUNITY PHYSICIANS
Doing business as
MUSC HELATH PRIMARY CARE - CAROLINA AVENUE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 17, 2012
Last certification
Nov 16, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 2021 in SC
Enrollment address
1619 Carolina Ave
Orangeburg, SC 29115-4939

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2000691Musc Health Primary Care - Carolina Ave1619 Carolina Avenue, Orangeburg, SC 29115Certificate of waiverDec 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Musc Community Physicians10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1619 Carolina Ave
Ste 215
Orangeburg, SC 29115

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lisa M Goodlett Individual Corporate OfficerCeo Mar 1, 2023 100%
Sonya Floyd Individual W-2 Managing EmployeeManager Mar 1, 2023 100%
Karyn Rae Individual Corporate DirectorChief, Payor Relations and Reimburs Mar 1, 2023 100%

Change-of-ownership history 1

DateEventCounterparty
Mar 1, 2023 Change of OwnershipThis provider was the buyer RMC Primary Care Carolina AveCCN 423883, SC, NPI 1639475429

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1285330688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23321",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873321",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 CAROLINA AVE STE 215",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154939",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSC COMMUNITY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "CHIEF, PAYOR RELATIONS",
        "authorized_official_telephone_number": "843-876-1344"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MUSC Health Primary Care - Carolina Ave",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orangeburg, SC

Sources for this page

Verify at the official NPI Registry.