NPIMap

Organization Active NPI

Musc Community Physicians

Doing business as MUSC Health Primary Care - Holly Hill

  • Rural Health Clinic/Center
  • Holly Hill, SC
National Provider Identifier
1508562901
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MUSC COMMUNITY PHYSICIANS
Doing business as
MUSC Health Primary Care - Holly Hill
Practice address
187 Bunch Ford Rd
Holly Hill, SC 29059-8224
Phone
(843) 792-1414
NPI assigned
Feb 7, 2023
Last updated
Feb 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
Karyn Rae
Title
Chief, Payor Relations
Phone
(843) 876-1344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

187 Bunch Ford Rd
Holly Hill, SC 29059-8224

Mailing address

PO Box 23321
New York, NY 10087-3321
Phone (843) 792-6200

Other names 1

  • MUSC Health Primary Care - Holly Hill Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231019003396 SC Part A Provider - Rural Health Clinic 6507260668 Practice locations: Holly Hill, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508562901. Details of each certification follow.

Rural health clinic certification: CCN 423821

Legal name
MUSC COMMUNITY PHYSICIANS
Doing business as
MUSC HEALTH PRIMARY CARE HOLLY HILL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 26, 1991
Last certification
Mar 14, 2023
Ownership / control type
2C
Most recent change of ownership
Jun 30, 2005 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 2022 in SC
Enrollment address
187 Bunch Ford Rd
Holly Hill, SC 29059-8224

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2340496Musc Health Primary Care- Holly Hill187 Bunch Ford Road, Holly Hill, SC 29059Certificate of waiverMar 17, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Lisa M Goodlett Individual Corporate OfficerCfo Mar 1, 2023
Sonya Floyd Individual W-2 Managing EmployeeManager Mar 1, 2023
Karyn Rae Individual Corporate DirectorChief, Payor Relations and Reimb Mar 1, 2023

Change-of-ownership history 1

DateEventCounterparty
Mar 1, 2023 Change of OwnershipThis provider was the buyer RMC Primary Care Holly HillCCN 423821, SC, NPI 1013060953

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1508562901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23321",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873321",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 BUNCH FORD RD",
            "city": "HOLLY HILL",
            "state": "SC",
            "postal_code": "290598224",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSC COMMUNITY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "CHIEF, PAYOR RELATIONS",
        "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 Primary Care - Holly Hill",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holly Hill, SC

Sources for this page

Verify at the official NPI Registry.