NPIMap

Organization Active NPI

Trident Anesthesia Group, LLC

  • Anesthesiology Physician
  • Charleston, SC
National Provider Identifier
1376595520
Registry record updated Jun 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
TRIDENT ANESTHESIA GROUP, LLC
Practice address
9263 Medical Plaza Dr.
Ste E
Charleston, SC 29406-7112
Phone
(843) 572-1228
Fax
(877) 561-7564
NPI assigned
May 16, 2006
Last updated
Jun 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2012

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

Authorized official

Name
Dr. Richard L Fishman, M.D.NPI 1518935352
Title
Partner
Phone
(843) 572-1228

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

9263 Medical Plaza Dr.
Ste E
Charleston, SC 29406-7112

Mailing address

9263 Medical Plaza Dr.
Ste E
Charleston, SC 29406-7112
Phone (843) 572-1228

Other identifiers 1

IdentifierTypeStateIssuer
GP0090MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209000391 SC Part B Supplier - Clinic/Group Practice 5294631545 Receives reassigned benefits from 152 practitioners
Practice locations: Charleston, SC; Summerville, SC; Mt Pleasant, SC

National Provider Directory

National Provider Directory
Tax ID family
Pain Care Physicians of Charleston LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

9263 Medical Plaza Dr
Ste B
North Charleston, SC 29406
Phone (843) 414-1224

9297 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 569-3603

9326 Medical Plaza Dr
#B
North Charleston, SC 29406
Phone (843) 572-1228

Practitioners & affiliated clinicians

Practitioners 208

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.

View all 208

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1376595520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9263 MEDICAL PLAZA DR.",
            "address_2": "STE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294067112",
            "telephone_number": "843-572-1228",
            "fax_number": "877-561-7564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9263 MEDICAL PLAZA DR.",
            "address_2": "STE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294067112",
            "telephone_number": "843-572-1228",
            "fax_number": "877-561-7564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT ANESTHESIA GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "FISHMAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "843-572-1228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0090",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.