NPIMap

Individual provider Active NPI

Thomas Childs Puckette

  • Body Imaging Physician
  • Mount Pleasant, SC
National Provider Identifier
1356350144
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
License
ME17812 Issued in SC
Practice address
1241 Woodland Avenue
Mount Pleasant, SC 29464
Phone
(843) 824-0606
Fax
(843) 824-0909
NPI assigned
Aug 8, 2006
Last updated
Jun 26, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X ME17812 SC Primary
Nuclear Radiology Physician 2085N0904X ME17812 SC
Pediatric Radiology Physician 2085P0229X ME17812 SC
Diagnostic Radiology Physician 2085R0202X ME17812 SC
Vascular & Interventional Radiology Physician 2085R0204X ME17812 SC
Diagnostic Ultrasound Physician 2085U0001X ME17812 SC

Addresses

Primary practice location

1241 Woodland Avenue
Mount Pleasant, SC 29464

Mailing address

1241 Woodland Avenue
Mount Pleasant, SC 29464
Phone (843) 824-0606

Other identifiers 5

IdentifierTypeStateIssuer
1138590OtherFIRST HEALTH
300125235OtherMEDICARE RR
8683OtherSCMEDICARE GROUP
1709OtherSCMEDICARE GROUP
T17906MedicaidSC

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
I20050504000353 SC Practitioner - Diagnostic Radiology 4284674771 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical University of South Carolina College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pelican II LLCGroup PAC ID 1759484082, 18 clinicians
Charleston Radiologists PAGroup PAC ID 9436054715, 35 clinicians

Practice addresses (Care Compare)

1241 Woodland Ave
Mt Pleasant, SC 29464-3288
Phone (843) 881-4020

201 Oakbrook LN
Suite 255
Summerville, SC 29485-7538
Phone (866) 717-9687

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.62 of 100Reported as group
Quality
79.55
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.22 of 100Reported as group
Quality
95.56
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME17812SCMDBody Imaging Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Radiologists PA Diagnostic Radiology CurrentSince Jul 1, 1995 Accepting new patients
Pelican II, LLC Body Imaging CurrentSince Sep 1, 2007 Accepting new patients
Advanced Diagnostic Imaging, LLC Pediatric Radiology Past Accepting new patients

Locations

1241 Woodland Ave
Mt Pleasant, SC 29464
Phone (843) 881-4020

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

201 Oakbrook Ln
Ste 255
Summerville, SC 29485
Phone (843) 851-2000

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 9

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214438400000",
    "number": "1356350144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 WOODLAND AVENUE",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "29464",
            "telephone_number": "843-824-0606",
            "fax_number": "843-824-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 WOODLAND AVENUE",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "29464",
            "telephone_number": "843-824-0606",
            "fax_number": "843-824-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETTE",
        "first_name": "THOMAS",
        "middle_name": "CHILDS",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2008-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "SC",
            "license": "ME17812",
            "primary": true
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "SC",
            "license": "ME17812",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "SC",
            "license": "ME17812",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "ME17812",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "SC",
            "license": "ME17812",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "SC",
            "license": "ME17812",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "1138590",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "300125235",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "8683",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "1709",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T17906",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

Verify at the official NPI Registry.