NPIMap

Organization Active NPI

Remedy Internal Medicine and Wellness Center P a

  • Internal Medicine Physician
  • Charleston, SC
National Provider Identifier
1316218670
Registry record updated Jul 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
24910 Issued in SC
Legal business name
REMEDY INTERNAL MEDICINE AND WELLNESS CENTER P A
Practice address
109 Wappoo Creek Dr
2A
Charleston, SC 29412-2135
Phone
(843) 737-5206
Fax
(843) 795-7171
NPI assigned
Jan 18, 2012
Last updated
Jul 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2013

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

Authorized official

Name
Dr. Shannon A Kennedy, M.D.NPI 1821022302
Title
Owner
Phone
(843) 737-5206

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24910 SC Primary
Pediatrics Physician 208000000X 24910 SC

Addresses

Primary practice location

109 Wappoo Creek Dr
2A
Charleston, SC 29412-2135

Mailing address

109 Wappoo Creek Dr
2A
Charleston, SC 29412-2135
Phone (843) 737-5206

Other identifiers 1

IdentifierTypeStateIssuer
GP5892MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120110000683 SC Part B Supplier - Clinic/Group Practice 0840466017 Receives reassigned benefits from 69 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aiken, SC; Summerville, SC; North Charleston, SC; Moncks Corner, SC; Lancaster, SC; Indian Land, SC; Goose Creek, SC; Edisto Island, SC…
O20120501000224 SC Part B Supplier - Clinic/Group Practice 1557523917 Receives reassigned benefits from 3 practitioners
Practice locations: Charleston, SC

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

109 Wappoo Creek Dr
Ste 2A
Charleston, SC 29412
Phone (843) 737-5206

418 Folly Rd
#A
Charleston, SC 29412
Phone (843) 225-8320

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7359/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 4

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": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373760000000",
    "number": "1316218670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 WAPPOO CREEK DR",
            "address_2": "2A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294122135",
            "telephone_number": "843-737-5206",
            "fax_number": "843-795-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 WAPPOO CREEK DR",
            "address_2": "2A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294122135",
            "telephone_number": "843-737-5206",
            "fax_number": "843-795-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REMEDY INTERNAL MEDICINE AND WELLNESS CENTER P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2013-07-14",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-737-5206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "24910",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "24910",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5892",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.