Individual provider Active NPI

Mariah Jordan Svantesson, PA

  • Physician Assistant
  • Mount Pleasant, SC
National Provider Identifier
1538636345
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0006527 Issued in CO
Practice address
851 Leonard Fulghum Dr Ste 101
Mount Pleasant, SC 29464-3793
Phone
(843) 971-9350
Fax
(843) 971-9351
NPI assigned
Oct 30, 2018
Last updated
Feb 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0006527 CO Primary
Surgical Physician Assistant 363AS0400X 3098 SC
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 3098 SC

Addresses

Primary practice location

851 Leonard Fulghum Dr Ste 101
Mount Pleasant, SC 29464-3793

Mailing address

851 Leonard Fulghum Dr Ste 101
Mount Pleasant, SC 29464-3793
Phone (843) 971-9350

Other practice location 1

1601 E 19th Ave Ste 6100
Denver, CO 80218-1255
Phone (303) 322-2206

Other names 1

  • Mariah Jordan McCallum Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MARIAH.MCCALLUM@hca3.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181226000130 SC Practitioner - Physician Assistant 2961747738 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Cooper Physician Group LLCGroup PAC ID 1254775687, 126 clinicians

Practice addresses (Care Compare)

2000 Hospital Dr
Mount Pleasant, SC 29464-3764
Phone (843) 881-0100

851 Leonard Fulghum Dr
Mt Pleasant, SC 29464-3793

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.63 of 100Reported as group
Quality
80.11
Promoting interoperability
100
Improvement activities
40
Cost
68.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3098SCMDSports Medicine (Orthopaedic Surgery) Physician
PA.0006527COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
East Cooper Physician Group LLC CurrentSince Feb 1, 2024 Accepting new patients
East Cooper Physician Group LLC CurrentSince Feb 1, 2024 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

7 S Alliance Dr
Ste 111B
Goose Creek, SC 29445
Phone (843) 352-4154

3400 Salterbeck St
Ste 100B
Mt Pleasant, SC 29466
Phone (843) 856-3262

851 Leonard Fulghum Dr
Ste 101
Mt Pleasant, SC 29464
Phone (843) 884-2133

Interoperability endpoints

  • Direct secure messaging: mariah.mccallum@hca3.eclinicaldirectplus.com
  • Direct secure messaging: mariah.svantesson.1@30548.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1538636345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 LEONARD FULGHUM DR STE 101",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643793",
            "telephone_number": "843-971-9350",
            "fax_number": "843-971-9351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 LEONARD FULGHUM DR STE 101",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643793",
            "telephone_number": "843-971-9350",
            "fax_number": "843-971-9351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 E 19th Ave Ste 6100",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802181255",
            "country_code": "US",
            "telephone_number": "303-322-2206",
            "fax_number": "303-861-0191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SVANTESSON",
        "first_name": "MARIAH",
        "middle_name": "JORDAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-30",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006527",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "3098",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "SC",
            "license": "3098",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MARIAH.MCCALLUM@hca3.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1601 E 19th Ave Ste 6100",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802181255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIAH",
            "last_name": "MCCALLUM",
            "middle_name": "JORDAN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mount Pleasant, SC

Sources for this page

Verify at the official NPI Registry.