Individual provider Active NPI

Katherine Elizabeth Chetta, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Charleston, SC
National Provider Identifier
1366886715
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
83523 Issued in SC
Practice address
10 McClennan Banks Drive Msc915
Charleston, SC 29425-3411
Phone
(843) 792-7021
NPI assigned
Apr 28, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 83523 SC Primary

Addresses

Primary practice location

10 McClennan Banks Drive Msc915
Charleston, SC 29425-3411

Mailing address

PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200

Other names 1

  • Katherine Elizabeth Wiley Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200806002163 SC Practitioner - Pediatric Medicine 0840615944 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
83523SCMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol CurrentSince Jul 15, 2020 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Jul 15, 2020 Accepting new patients
Medical University Hospital Authority Past Accepting new patients

Locations

10 McClennan Banks Dr
#915
Charleston, SC 29401
Phone (843) 792-7021

10 McClennan Banks Dr
Charleston, SC 29401
Phone (843) 330-9824

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1367107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1366886715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MCCLENNAN BANKS DRIVE MSC915",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294253411",
            "telephone_number": "843-792-7021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHETTA",
        "first_name": "KATHERINE",
        "middle_name": "ELIZABETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-28",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "SC",
            "license": "83523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "WILEY",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.