Individual provider Active NPI

Sharon Alissa Johnson Brunson, MA CCC/SLP

  • Speech-Language Pathologist
  • Orangeburg, SC
National Provider Identifier
1407026800
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2255 Issued in SC
Practice address
397 Brookdale Dr
Orangeburg, SC 29115-3907
Phone
(803) 707-6962
Fax
(803) 937-5642
NPI assigned
Mar 3, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2255 SC Primary

Addresses

Primary practice location

397 Brookdale Dr
Orangeburg, SC 29115-3907

Mailing address

397 Brookdale Dr
Orangeburg, SC 29115-3907
Phone (803) 707-6962

Other identifiers 1

IdentifierTypeStateIssuer
SA093MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240917003700 SC Practitioner - Qualified Speech Language Pathologist 7618418781 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Weston Group of South Carolina IncGroup PAC ID 2062651185, 80 clinicians

Practice addresses (Care Compare)

60 Oak Forest Rd
Bluffton, SC 29910-5010
Phone (843) 815-5557

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
2255SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Weston Group of South Carolina Inc Speech-Language Pathologist CurrentSince Aug 6, 2024 Accepting new patients

Locations

872 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 347-3050

3736 Robert M Grissom Pkwy
Myrtle Beach, SC 29577
Phone (843) 448-9300

1687 Longwood Dr
Orangeburg, SC 29118
Phone (803) 535-0250

Organizations & group practices 1

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": "1204502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473724800000",
    "number": "1407026800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 BROOKDALE DR",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291153907",
            "telephone_number": "803-707-6962",
            "fax_number": "803-937-5642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 BROOKDALE DR",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291153907",
            "telephone_number": "803-707-6962",
            "fax_number": "803-937-5642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON BRUNSON",
        "first_name": "SHARON",
        "middle_name": "ALISSA",
        "name_prefix": "Ms.",
        "credential": "MA CCC/SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-03",
        "last_updated": "2016-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "2255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SA093",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.