NPIMap

Individual provider Active NPI

Maria Malatanos Kennickell, PA-C

  • Physician Assistant
  • Mount Pleasant, SC
National Provider Identifier
1447400171
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2729 Issued in SC
Practice address
1300 Hospital Dr Ste 300
Mount Pleasant, SC 29464-3217
Phone
(843) 884-5200
NPI assigned
Sep 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2729 SC Primary

Addresses

Primary practice location

1300 Hospital Dr Ste 300
Mount Pleasant, SC 29464-3217

Mailing address

1300 Hospital Dr Ste 300
Mount Pleasant, SC 29464-3217
Phone (843) 793-5182

Other identifiers 1

IdentifierTypeStateIssuer
2999PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170804003103 SC Practitioner - Physician Assistant 8820155922 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
George Washington University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Cooper Physician Group LLCGroup PAC ID 1254775687, 126 clinicians

Practice addresses (Care Compare)

1300 Hospital Dr
Suite 300
Mt Pleasant, SC 29464-3217
Phone (843) 884-5200

851 Leonard Fulghum Dr
Mt Pleasant, SC 29464-3793

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2729SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Gastroenterology Specialists CurrentSince Jan 1, 2018 Accepting new patients
East Cooper Physician Group LLC CurrentSince Jan 1, 2025 Accepting new patients
East Cooper Physician Group LLC Past Accepting new patients

Locations

1962 Charlie Hall Blvd
Charleston, SC 29414
Phone (803) 722-8000

851 Leonard Fulghum Dr
Ste 101
Mt Pleasant, SC 29464
Phone (843) 884-2133

1300 Hospital Dr
Ste 300
Mt Pleasant, SC 29464
Phone (803) 884-5200

2001 2nd Ave
Ste 101
Summerville, SC 29486
Phone (843) 722-8000

Organizations & group practices 5

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1447400171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 HOSPITAL DR STE 300",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643217",
            "telephone_number": "843-793-5182",
            "fax_number": "843-266-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 HOSPITAL DR STE 300",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643217",
            "telephone_number": "843-884-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNICKELL",
        "first_name": "MARIA",
        "middle_name": "MALATANOS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-30",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2999PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

Verify at the official NPI Registry.