Active NPI
Taylor Mayberry
- Physical Therapist
- North Charleston, SC
National Provider Identifier
1407539604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 9241 University Blvd Ste a
North Charleston, SC 29406-9349 - Phone
- (843) 764-4887
- Fax
- (843) 764-4509
- NPI assigned
- Aug 14, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
9241 University Blvd Ste a
North Charleston, SC 29406-9349
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Other practice location 1
5272 7th Green Dr
Hollywood, SC 29449-5976
Phone (502) 442-3087
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC, CT
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
90 Wall St
Suite 100
Madison, CT 06443-3128
Phone (475) 522-6030
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.49 of 100
- Quality
- 89.43
- Improvement activities
- 40
- Cost
- 74.33
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11971 | SC | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grazen Corporation | Physical Therapist | Current | Accepting new patients |
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": "1691971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692576000000",
"number": "1407539604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9241 UNIVERSITY BLVD STE A",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294069349",
"telephone_number": "843-764-4887",
"fax_number": "843-764-4509"
}
],
"practiceLocations": [
{
"address_1": "5272 7th Green Dr",
"address_purpose": "LOCATION",
"city": "Hollywood",
"state": "SC",
"postal_code": "294495976",
"country_code": "US",
"telephone_number": "502-442-3087",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAYBERRY",
"first_name": "TAYLOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-14",
"last_updated": "2023-08-21",
"certification_date": "2023-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.