Musc Community Physicians
Organization Active NPI Rural Health Clinic/Center · Holly Hill, SC
NPI 1508562901 · NPPES record last updated Feb 7, 2023
Key facts
- NPI
- 1508562901
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MUSC COMMUNITY PHYSICIANS
- Practice address
- 187 Bunch Ford Rd
Holly Hill, SC 29059-8224 - Phone
- (843) 792-1414
- NPI assigned
- Feb 7, 2023
- Organization subpart
- No
Authorized official
- Name
- Karyn Rae
- Title
- Chief, Payor Relations
- Phone
- (843) 876-1344
Other NPIs with the same Medicare PAC ID 8
Change of ownership 1
Practitioners 1,353
-
Sheron Denise Abraham, D.O.
-
Erica Nicole Adams, FNP-BC
-
Michael Todd Adams, CRNA, ARNP
-
Sara Elizabeth Adams, M.D.
-
Candace Anne Aguiar, CRNA
-
Rahoul Ahuja, M.D.
-
David Ajibade, MD
-
Idowu Afolarin Ajose, M.D.
-
Reem Akel, MD
-
Ribal Al Aridi, M.D
-
Moayad Al Hadidi, M.D.
-
Ramzy Al-Hourany, MD
-
Mitchell Todd Alderson, M.D.
-
Duaa Alkhader, MD
-
Jason Allen, PMHNP-BC
-
Raymond Keels Allen Jr., M.D.
-
Scott H Allen, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D2340496 | Musc Health Primary Care- Holly Hill | Certificate of waiver | Mar 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
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
- Corporation · Non-profit
- Incorporated
- Mar 1, 2022 in SC
- Enrollment address
- 187 Bunch Ford Rd
Holly Hill, SC 29059-8224
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Lisa M Goodlett |
Corporate Officer |
Mar 1, 2023 | |
| Sonya Floyd |
W-2 Managing Employee |
Mar 1, 2023 | |
| Karyn Rae |
Corporate Director |
Mar 1, 2023 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Mar 1, 2023 | Change of Ownership |
RMC Primary Care Holly Hill |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231019003396 | SC | Part a Provider - Rural Health Clinic | 6507260668 | Practice locations: Holly Hill, SC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- MUSC Health Primary Care - Holly Hill
Other providers in Holly Hill, SC
- Matthew Nicholas Kunkelman
- Troy Blakely Lamb
- Shaunette L Lloyd
- Ashley Victoria Mack
- David Mickell
- Michael James Myers
- New Phase Home Care LLC
- Newsmile
- Nra-Holly Hill, South Carolina, LLC
- Orangeburg Consolidated School District Three
All providers in Holly Hill, SC · Rural Health Clinic/Center in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.