NPIMap

Organization Active NPI

Sungate Primary Care

  • Family Medicine Physician
  • Bluffton, SC
National Provider Identifier
1366786485
Registry record updated Nov 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO 985 Issued in SC
Legal business name
SUNGATE PRIMARY CARE
Practice address
10 William Pope Drive
Sungate Medical Center
Bluffton, SC 29909
Phone
(843) 705-1510
Fax
(843) 705-1511
NPI assigned
Nov 15, 2012
Organization subpart
Yes
Parent organization
PALMETTO EYE SPECIALISTS PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2012

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

Authorized official

Name
Dr. Kenneth Daniel Farr, MD
Title
Medical Director
Phone
(843) 842-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X DO 985 SC Primary

Addresses

Primary practice location

10 William Pope Drive
Sungate Medical Center
Bluffton, SC 29909

Mailing address

10 William Pope Drive
Sungate Medical Center
Bluffton, SC 29909
Phone (843) 705-1510

Other identifiers 2

IdentifierTypeStateIssuer
CH3121OtherRAILROAD MEDICARE
GP2666MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Sungate Dermatology3 organizations share this tax ID, including this one
Part of
Sungate Dermatology

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1366786485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WILLIAM POPE DRIVE",
            "address_2": "SUNGATE MEDICAL CENTER",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "29909",
            "telephone_number": "843-705-1510",
            "fax_number": "843-705-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WILLIAM POPE DRIVE",
            "address_2": "SUNGATE MEDICAL CENTER",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "29909",
            "telephone_number": "843-705-1510",
            "fax_number": "843-705-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNGATE PRIMARY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALMETTO EYE SPECIALISTS PA",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "FARR",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "843-842-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "DO 985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH3121",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2666",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bluffton, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.