Individual provider Active NPI

Perin W Diana Jr., MD

  • Ophthalmology Physician
  • Varnville, SC
National Provider Identifier
1295791598
Registry record updated Oct 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
20809 Issued in SC
Practice address
1000 Pine Street
Varnville, SC 29944-0969
Phone
(803) 943-5228
Fax
(803) 943-4591
NPI assigned
Apr 25, 2006
Last updated
Oct 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 20809 SC Primary

Addresses

Primary practice location

1000 Pine Street
Varnville, SC 29944-0969

Mailing address

55 Meriden Ave
Ste 2D
Southington, CT 06489-3235
Phone (843) 726-6509

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20071207000356 SC Practitioner - Ophthalmology 9537258959 Reassigns benefits to 1 organization
I20120315000138 CT Practitioner - Ophthalmology 9537258959

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Perelman School of Med at the University of Pennsylvania, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaufort Eye Center P aGroup PAC ID 1052407640, 6 clinicians

Practice addresses (Care Compare)

1664 Ribaut Rd
Port Royal, SC 29935-1708
Phone (843) 522-8466

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20809SCMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beaufort Eye Optical Ophthalmology CurrentSince Nov 5, 2023 Accepting new patients
Sungate Medical Group LLC Ophthalmology Past Accepting new patients
Palmetto Eye Specialists, P.a. Ophthalmology PastSince Jan 1, 2006 Accepting new patients
University Medical Associates of the Medical University of South Carol Past Accepting new patients

Locations

1664 Ribaut Rd
Port Royal, SC 29935
Phone (843) 522-8466

Interoperability endpoints

  • Direct secure messaging: pdiana@bec.intellechartdirect.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1295791598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MERIDEN AVE",
            "address_2": "STE 2D",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064893235",
            "telephone_number": "843-726-6509",
            "fax_number": "843-726-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 PINE STREET",
            "city": "VARNVILLE",
            "state": "SC",
            "postal_code": "299440969",
            "telephone_number": "803-943-5228",
            "fax_number": "803-943-4591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIANA",
        "first_name": "PERIN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "SC",
            "license": "20809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Varnville, SC

Sources for this page

Verify at the official NPI Registry.