NPIMap

Organization Active NPI

Palmetto Adult and Childrens Urology PA

  • Urology Physician
  • North Charleston, SC
National Provider Identifier
1467440644
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
PALMETTO ADULT AND CHILDRENS UROLOGY PA
Practice address
2890 Tricom St
North Charleston, SC 29406-9171
Phone
(843) 797-6600
Fax
(843) 820-1440
NPI assigned
Oct 11, 2005
Last updated
Apr 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Authorized official

Name
Mrs. Amelia Munkberg
Title
Practice Administrator
Phone
(843) 797-6600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

2890 Tricom St
North Charleston, SC 29406-9171

Mailing address

2890 Tricom St
North Charleston, SC 29406-9171
Phone (843) 797-6600

Other practice location 1

302 Medical Park Dr Ste 207
Walterboro, SC 29488-5749
Phone (843) 797-6600

Other practice location 2

5500 Front St Ste 250
Summerville, SC 29486-8140
Phone (843) 797-6600

Other practice location 3

104 Morgan Pl Ste C
Summerville, SC 29485-8106
Phone (843) 797-6600

Other identifiers 2

IdentifierTypeStateIssuer
GP4871MedicaidSC
7026OtherSCMEDICARE GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080520000258 SC Part B Supplier - Clinic/Group Practice 1254400021 Receives reassigned benefits from 8 practitioners
Practice locations: N Charleston, SC; Walterboro, SC

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

104 Morgan Pl
Ste C
Summerville, SC 29485
Phone (843) 797-6600

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1467440644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2890 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069171",
            "telephone_number": "843-797-6600",
            "fax_number": "843-820-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2890 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069171",
            "telephone_number": "843-797-6600",
            "fax_number": "843-820-1440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "302 Medical Park Dr Ste 207",
            "address_purpose": "LOCATION",
            "city": "Walterboro",
            "state": "SC",
            "postal_code": "294885749",
            "country_code": "US",
            "telephone_number": "843-797-6600",
            "fax_number": "843-820-1440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5500 Front St Ste 250",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294868140",
            "country_code": "US",
            "telephone_number": "843-797-6600",
            "fax_number": "843-820-1440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Morgan Pl Ste C",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294858106",
            "country_code": "US",
            "telephone_number": "843-797-6600",
            "fax_number": "843-820-1440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALMETTO ADULT AND CHILDRENS UROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "MUNKBERG",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "843-797-6600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4871",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "7026",
            "state": "SC"
        }
    ],
    "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 Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.