Active NPI
Patricia N Rae, PA
- Physician Assistant
- Spartanburg, SC
National Provider Identifier
1376562801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 004742
- Practice address
- 853 N Church St
Suite 720C
Spartanburg, SC 29303-3098 - Phone
- (864) 560-6419
- Fax
- (864) 560-7498
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004742 | NY | Primary |
Addresses
Primary practice location
853 N Church St
Suite 720C
Spartanburg, SC 29303-3098
Mailing address
PO Box 2168
Spartanburg, SC 29304-2168
Phone (864) 560-4304
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0622PA | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205884800000",
"number": "1376562801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2168",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293042168",
"telephone_number": "864-560-4304",
"fax_number": "864-560-4413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "853 N CHURCH ST",
"address_2": "SUITE 720C",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293033098",
"telephone_number": "864-560-6419",
"fax_number": "864-560-7498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAE",
"first_name": "PATRICIA",
"middle_name": "N",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2008-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "004742",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0622PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spartanburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.