NPIMap

Individual provider Active NPI

Justin Tyler Runey, PA-C

  • Surgical Physician Assistant
  • North Charleston, SC
National Provider Identifier
1336490739
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA 1842 Issued in SC
Practice address
2880 Tricom St
North Charleston, SC 29406-9171
Phone
(843) 797-5050
Fax
(843) 797-3633
NPI assigned
Sep 25, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA 1842 SC
Surgical Physician Assistant 363AS0400X PA 1842 SC Primary

Addresses

Primary practice location

2880 Tricom St
North Charleston, SC 29406-9171

Mailing address

2880 Tricom St
North Charleston, SC 29406-9171
Phone (843) 797-5050

Other identifiers 6

IdentifierTypeStateIssuer
1874PAMedicaidSC
P01337423OtherSCRAILROAD MEDICARE PTAN
DU4331OtherSCARCIS HEALTHCARE GROUP RAILROAD MEDICARE PTAN
GP6337OtherSCARCIS HEALTHCARE GROUP MEDICAID NO.
D043OtherSCARCIS HEALTHCARE GROUP MEDICARE PTAN
1902246077OtherSCARCIS HEALTHCARE GROUP NPI

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
I20140509001474 SC Practitioner - Physician Assistant 5799918173 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arcis Healthcare LLC 34 clinicians

Practice addresses (Care Compare)

130 E 3Rd N St
Summerville, SC 29483-6810
Phone (843) 797-5050

2880 Tricom St
North Charleston, SC 29406-9171
Phone (843) 797-5050

9565 Hwy 78
BLDG 100
Ladson, SC 29456-4118
Phone (843) 797-5050

Hospital & facility affiliations

  • Trident Medical Center Hospital, Charleston, SC, CCN 420079
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Roper Hospital Hospital, Charleston, SC, CCN 420087

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA 1842SCMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Arcis Healthcare, LLC CurrentSince Feb 25, 2014 Accepting new patients
Arcis Healthcare, LLC Medical CurrentSince Feb 25, 2014 Accepting new patients

Locations

1951 Clements Ferry Rd
Ste 100
Charleston, SC 29492
Phone (843) 797-5050

2880 Tricom St
North Charleston, SC 29406
Phone (843) 797-5050

93 Springview Ln
Unit B
Summerville, SC 29485
Phone (843) 266-4883

130 E 3rd North St
Summerville, SC 29483
Phone (843) 797-5050

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1336490739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2880 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069171",
            "telephone_number": "843-797-5050",
            "fax_number": "843-797-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069171",
            "telephone_number": "843-797-5050",
            "fax_number": "843-797-3633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNEY",
        "first_name": "JUSTIN",
        "middle_name": "TYLER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-25",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "PA 1842",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "PA 1842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1874PA",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P01337423",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARCIS HEALTHCARE GROUP RAILROAD MEDICARE PTAN",
            "identifier": "DU4331",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARCIS HEALTHCARE GROUP MEDICAID NO.",
            "identifier": "GP6337",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARCIS HEALTHCARE GROUP MEDICARE PTAN",
            "identifier": "D043",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARCIS HEALTHCARE GROUP NPI",
            "identifier": "1902246077",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

Verify at the official NPI Registry.