NPIMap

Organization Active NPI

Roper Hospital, Inc.

Doing business as Vascular Medicine and Wound Management Clinic

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Moncks Corner, SC
National Provider Identifier
1487315164
Registry record updated Mar 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
Legal business name
ROPER HOSPITAL, INC.
Doing business as
Vascular Medicine and Wound Management Clinic
Practice address
3508 S Live Oak Dr Ste 200
Moncks Corner, SC 29461-8737
Phone
(843) 724-2289
Fax
(843) 606-8038
NPI assigned
Jan 5, 2022
Last updated
Mar 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2024

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

Authorized official

Name
William A. JacksonNPI 1760471130
Title
VP Coo
Phone
(843) 839-1201

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083P0011X Primary

Addresses

Primary practice location

3508 S Live Oak Dr Ste 200
Moncks Corner, SC 29461-8737

Mailing address

PO Box 751649
Charlotte, NC 28275-1649
Phone (888) 472-0043

Other names 1

  • Vascular Medicine and Wound Management Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041228000500 SC Part B Supplier - Clinic/Group Practice 8426958919 Receives reassigned benefits from 156 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Walterboro, SC; N Charleston, SC; Mt Pleasant, SC; Moncks Corner, SC; Goose Creek, SC; Charleston, SC

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Chas Thoracic Cardiovas26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

8536 Palmetto Commerce Pkwy
Ste 501
Ladson, SC 29456
Phone (843) 203-2260

Practitioners & affiliated clinicians

Practitioners 2

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": "1641340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710633600000",
    "number": "1487315164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751649",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751649",
            "telephone_number": "888-472-0043",
            "fax_number": "843-724-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3508 S LIVE OAK DR STE 200",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294618737",
            "telephone_number": "843-724-2289",
            "fax_number": "843-606-8038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROPER HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-05",
        "last_updated": "2024-03-17",
        "certification_date": "2024-03-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "VP COO",
        "authorized_official_telephone_number": "843-839-1201"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "272 Dundee Rd, #302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60062",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Vascular Medicine and Wound Management Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moncks Corner, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.