Active NPI
Amy Lynn Trolley, PAC
- Surgical Physician Assistant
- Charleston, SC
National Provider Identifier
1447371737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 627
- Practice address
- 109 Bee St
Charleston, SC 29401-5703 - Phone
- (843) 577-5011
- NPI assigned
- Apr 3, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 627 | SC | Primary |
| Surgical Physician Assistant | 363AS0400X | 020341 | NY | |
| Physician Assistant | 363A00000X | 50001943 | OH |
Addresses
Primary practice location
109 Bee St
Charleston, SC 29401-5703
Mailing address
109 Bee St
Charleston, SC 29401-5703
Phone (843) 577-5011
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0068585 | Other | OH | MEDICAID |
| H021220 | Other | OH | MEDICARE |
| 720614 | Other | OH | ANTHEM |
| 9720708 | Other | OH | AETNA |
| 1632131 | Other | OH | GATEWAY HEALTH |
| 270577733079 | Other | OH | CARESOURCE |
| 779386/713428 | Other | OH | BUCKEYE MEDICAID/MEDICARE |
| P01238565 | Other | OH | RAILROAD MEDICARE |
| 1447371737 | Other | OH | MEDICAL MUTUAL |
| 610902 | Other | OH | WELLCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170403000470 | SC | Order and Referring Only - Physician Assistant | 2769653914 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50001943 | OH | MD | Physician Assistant |
Interoperability endpoints
- amy.trolley@ppcp1.eclinicaldirectplus.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490313600000",
"number": "1447371737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 BEE ST",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294015703",
"telephone_number": "843-577-5011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 BEE ST",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294015703",
"telephone_number": "843-577-5011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TROLLEY",
"first_name": "AMY",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2017-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "SC",
"license": "627",
"primary": true
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NY",
"license": "020341",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50001943",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID",
"identifier": "0068585",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "H021220",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "720614",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "9720708",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY HEALTH",
"identifier": "1632131",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "270577733079",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUCKEYE MEDICAID/MEDICARE",
"identifier": "779386/713428",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01238565",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL MUTUAL",
"identifier": "1447371737",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "610902",
"state": "OH"
}
],
"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 Mar 24, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.