Vickie Glover, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

00047961 Issued in SC

Practice address

13649 Church Street
Williston, SC 29853

Phone

(803) 266-0060

Fax

(803) 266-0042

NPI assigned

Jul 27, 2006

Last updated

Jan 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Vickie Ray Former name

Medicare fee-for-service enrollment

Enrolled in SC, AK2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Medical University of South Carolina College of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Low Country Health Care System IncGroup PAC ID 4284530940, shared by 10 NPIs, 33 clinicians

Camai Community Health Center IncGroup PAC ID 3476690876, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vickie.glover.1@20726.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Camai Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Naknek, AK
  • NPI 1679718019
  Medicare reassignment Care Compare group
• Low Country Health Care System, Inc

  dba Bamberg Specialty Services

  • Federally Qualified Health Center (FQHC)
  • Bamberg, SC
  • NPI 1306378310
  Medicare reassignment NPD
• Low Country Health Care System, Inc

  dba Barnwell Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Barnwell, SC
  • NPI 1578659942
  Medicare reassignment NPD
• Low Country Health Care System, Inc

  dba Barnwell Family Specialty Services

  • Federally Qualified Health Center (FQHC)
  • Barnwell, SC
  • NPI 1780112912
  Medicare reassignment NPD
• Low Country Health Care System, Inc

  dba Padgett Family Practice

  • Federally Qualified Health Center (FQHC)
  • Bamberg, SC
  • NPI 1821518556
  Medicare reassignment NPD
• Low Country Health Care System, Inc.

  dba Family Medical Center of Blackville

  • Federally Qualified Health Center (FQHC)
  • Blackville, SC
  • NPI 1235225608
  Medicare reassignment NPD
• Low Country Health Care System, Inc

  dba Barnwell Pediatrics

  • Federally Qualified Health Center (FQHC)
  • Barnwell, SC
  • NPI 1962442244
  NPD
• Low Country Health Care System, Inc.

  dba Aiken Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Aiken, SC
  • NPI 1194288571
  NPD
• Low Country Health Care System, Inc

  dba Williston Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Williston, SC
  • NPI 1922468826
  NPD (past)
• Alaska Imaging Associates, LLC

  dba Northern Lights Imaging

  • Diagnostic Radiology Physician
  • Anchorage, AK
  • NPI 1063466688
  NPD (past)
• Bristol Bay Borough

  dba Camai Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Naknek, AK
  • NPI 1629105804
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1386668648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 WREN STREET",
            "city": "BARNWELL",
            "state": "SC",
            "postal_code": "29812",
            "telephone_number": "803-259-5762",
            "fax_number": "803-259-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13649 CHURCH STREET",
            "city": "WILLISTON",
            "state": "SC",
            "postal_code": "29853",
            "telephone_number": "803-266-0060",
            "fax_number": "803-266-0042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLOVER",
        "first_name": "VICKIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "00047961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "P19236",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0020PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICKIE",
            "last_name": "RAY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tasha Michelle Bowman, ATC
• Carlyle Senior Care of Williston LLC (Carlyle Senior Care of Williston)
• Carolina Rural Practice Management, Inc. (Williston Medical Center)
• Elise Faulkner
• Cheryl Lee Gentry, PTA
• Jaleel Hammonds
• Carol Heller, RPH
• Hometown Heroes Healthcare, LLC
• Rebekah Ashlyn Koon, PHARM.D.
• Low Country Health Care System, Inc (Williston Family Medicine)

• Physician Assistant in Williston, SC
• Providers in Williston, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.