NPIMap

Organization Active NPI

Uderitz Family Psychiatry, LLC

  • Psychiatry Physician
  • Johns Island, SC
National Provider Identifier
1477077329
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
34478 Issued in SC
Legal business name
UDERITZ FAMILY PSYCHIATRY, LLC
Practice address
3227 Walter Dr Ste 3B
Johns Island, SC 29455-8171
Phone
(843) 872-5454
Fax
(843) 872-5501
NPI assigned
Aug 2, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Authorized official

Name
Daniel Jay Uderitz, MDNPI 1295963437
Title
Owner - Psychiatrist
Phone
(843) 872-5454

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 34478 SC Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X 34478 SC

Addresses

Primary practice location

3227 Walter Dr Ste 3B
Johns Island, SC 29455-8171

Mailing address

3227 Walter Dr Ste 1B
Johns Island, SC 29455-8171
Phone (843) 872-5454

Other practice location 1

3227 Walter Dr Ste 1B
Johns Island, SC 29455-8171
Phone (843) 872-5454

Other names 1

  • Angel Oak Counseling Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171009001780 SC Part B Supplier - Clinic/Group Practice 8325313851 Receives reassigned benefits from 7 practitioners
Practice locations: Johns Island, SC

National Provider Directory

National Provider Directory

Locations

3227 Walter Dr
Ste 1B
Johns Island, SC 29455
Phone (843) 872-5454

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1477077329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3227 WALTER DR STE 1B",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294558171",
            "telephone_number": "843-872-5454",
            "fax_number": "843-872-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3227 WALTER DR STE 3B",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294558171",
            "telephone_number": "843-872-5454",
            "fax_number": "843-872-5501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3227 Walter Dr Ste 1B",
            "address_purpose": "LOCATION",
            "city": "Johns Island",
            "state": "SC",
            "postal_code": "294558171",
            "country_code": "US",
            "telephone_number": "843-872-5454",
            "fax_number": "843-872-5501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UDERITZ FAMILY PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-02",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "UDERITZ",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER - PSYCHIATRIST",
        "authorized_official_telephone_number": "843-872-5454",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "34478",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "SC",
            "license": "34478",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angel Oak Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johns Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.