NPIMap

Organization Active NPI

Trident Dermatology, PA

Doing business as Trident Dermatology

  • Dermatology Physician
  • Charleston, SC
National Provider Identifier
1366404659
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
10773 Issued in SC
Legal business name
TRIDENT DERMATOLOGY, PA
Doing business as
Trident Dermatology
Practice address
9295 Medical Plaza Dr
B
Charleston, SC 29406-9137
Phone
(843) 797-3960
NPI assigned
Apr 4, 2006
Last updated
Aug 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Authorized official

Name
Blake Aaron Guinn
Title
Practice Manager
Phone
(843) 797-3960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 10773 SC Primary

Addresses

Primary practice location

9295 Medical Plaza Dr
B
Charleston, SC 29406-9137

Mailing address

9295 Medical Plaza Dr
B
Charleston, SC 29406-9137
Phone (843) 797-3960

Other identifiers 2

IdentifierTypeStateIssuer
PA5761MedicaidSC
CK8300OtherSCMEDICARE RAILROAD

Other names 1

  • Trident Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101116000571 SC Part B Supplier - Clinic/Group Practice 5092774034 Receives reassigned benefits from 10 practitioners
Practice locations: Charleston, SC

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
42D0682447Trident Dermatology9295 Medical Plaza Drive, Suite a, North Charleston, SC 29406ComplianceMar 15, 2028

National Provider Directory

National Provider Directory

Locations

9295 Medical Plaza Dr
Ste A
Charleston, SC 29406
Phone (843) 797-3960

9295 Medical Plaza Dr
Ste B
Charleston, SC 29406
Phone (843) 797-3960

9295 Medical Plaza Dr
Ste Ab
North Charleston, SC 29406
Phone (843) 797-3960

Practitioners & affiliated clinicians

Practitioners 12

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": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1366404659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9295 MEDICAL PLAZA DR",
            "address_2": "B",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294069137",
            "telephone_number": "843-797-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9295 MEDICAL PLAZA DR",
            "address_2": "B",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294069137",
            "telephone_number": "843-797-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A",
        "authorized_official_last_name": "GUINN",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "843-797-3960"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SC",
            "license": "10773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA5761",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CK8300",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trident Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trident Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.