Charleston Medical Associates

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CHARLESTON MEDICAL ASSOCIATES

Doing business as

Generations Pediatrics and Internal Medicine

Practice address

1483 Tobias Gadson Blvd Ste 101
Charleston, SC 29407-4795

Phone

(843) 405-1110

NPI assigned

May 10, 2018

Organization subpart

Yes

Parent organization

CHARLESTON MEDICAL ASSOCIATESAs reported in NPPES

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

Authorized official

Name

Dr. Matthew Justice Kornegay, MDNPI 1922042654

Title

Managing Partner

Phone

(843) 614-7953

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Generations Pediatrics and Internal Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Charleston Medical

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Justice Kornegay Jr., MD

  • Pediatrics Physician
  • Charleston, SC
  • NPI 1922042654
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525910400000",
    "number": "1376033829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1483 TOBIAS GADSON BLVD STE 101",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074795",
            "telephone_number": "843-405-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1483 TOBIAS GADSON BLVD STE 101",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074795",
            "telephone_number": "843-405-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON MEDICAL ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLESTON MEDICAL ASSOCIATES",
        "enumeration_date": "2018-05-10",
        "last_updated": "2018-05-10",
        "status": "A",
        "authorized_official_last_name": "KORNEGAY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JUSTICE",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "843-614-7953",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311442",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Generations Pediatrics and Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charleston Hope
• Charleston Integrated Counseling, LLC
• Charleston Internal Medicine, LLC
• Charleston Jaw Surgery
• Charleston Maternal Fetal Medicine LLC
• Charleston Medical Clinic
• Charleston Medicine and Behavioral Health, LLC
• Charleston Memorial Hospital
• Charleston Memorial Hospital
• Charleston Mental Wellness, LLC

• Primary Care Clinic/Center in Charleston, SC
• Providers in Charleston, SC by specialty
• Primary Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; 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.