Medical University Hospital Authority

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Doing business as

MUSC Health Express Care Lake City

Practice address

148 Sauls St Ste E
Lake City, SC 29560-2677

Phone

(843) 669-9183

NPI assigned

Oct 22, 2020

Organization subpart

No

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

Authorized official

Name

Karyn Rae

Title

Chief

Phone

(843) 876-1344

Specialties & licenses 1

Addresses

Other names 1

• MUSC Health Express Care Lake City Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457950222. Details of each certification follow.

• CCN 423485 Rural health clinic · Active · Details

Rural health clinic certification: CCN 423485

Legal name

MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Doing business as

MUSC HEALTH EXPRESS CARE LAKE CITY

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Feb 24, 2021

Last certification

Jul 2, 2024

Ownership / control type

2B

Organization structure

OtherNon-profit

Enrollment address

148 Sauls Street Ste E
Lake City, SC 29560-2677

Related CCNs

420019

Related certifications (CCN) 1

Facilities connected through Provider of Services related, parent or unit certification numbers.

• Medical University Hospital Authority

  dba MUSC Health Chester Medical Center

  • General Acute Care Hospital
  • Chester, SC
  • NPI 1437622933

  Parent provider

  Provider of Services

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 11

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Hannah Carsten Bingham, FNP-C

  • Family Nurse Practitioner
  • Lake City, SC
  • NPI 1609546472
  NPD (past)
• Matthew Ryan Bingham, PA

  • Medical Physician Assistant
  • Florence, SC
  • NPI 1134705031
  NPD (past)
• Krista Bridges

  • Family Nurse Practitioner
  • Lake City, SC
  • NPI 1346113131
  NPD (past)
• Caitlin Altman Jordan, PA-C

  • Medical Physician Assistant
  • Lake City, SC
  • NPI 1831745710
  NPD (past)
• Pamela Lewis, FNP-C

  • Family Nurse Practitioner
  • Lake City, SC
  • NPI 1376260554
  NPD (past)
• Madison Graham Wiggins, PA-C

  • Physician Assistant
  • Kingstree, SC
  • NPI 1982467239
  NPD (past)

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663891200000",
    "number": "1457950222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23467",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873467",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 SAULS ST STE E",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602677",
            "telephone_number": "843-669-9183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL UNIVERSITY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "843-876-1344"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MUSC Health Express Care Lake City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MUSC Health Express Care Lake City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• McLeod Physician Associates II (McLeod Primary Care Lake City)
• McLeod Physician Associates II (McLeod Family Medicine Center - Lake City)
• McLeod Physician Associates, Inc (McLeod Family Medicine Center - Lake City)
• Medical Consultants of Lake City LLC
• Medical University Hospital Authority (MUSC Health Primary Care - Ron McNair Blvd)
• Medical University Hospital Authority (MUSC Health Primary Care Lake City)
• Medicine Cabinet Clinical Services LLC (The Medicine Cabinet Clinical Services)
• Medicine Cabinet of Lake City (The Medicine Cabinet)
• Medtran Express
• Mid-Carolina Hospital Group, LLC (Lake City Community Hospital)

• Rural Health Clinic/Center in Lake City, SC
• Providers in Lake City, SC by specialty
• Rural Health Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.