NPIMap

Individual provider Active NPI

John Mark Redwine Sr., MD

  • Family Medicine Physician
  • Charleston, SC
National Provider Identifier
1548227101
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
13521 Issued in SC
Practice address
5325 Appian Way
Charleston, SC 29420
Phone
(843) 552-0400
Fax
(843) 552-1618
NPI assigned
Apr 27, 2006
Last updated
Jun 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 13521 SC Primary

Addresses

Primary practice location

5325 Appian Way
Charleston, SC 29420

Mailing address

PO Box 530062
Atlanta, GA 30353-0062
Phone (843) 695-6071

Other identifiers 3

IdentifierTypeStateIssuer
060041439OtherSCRR MEDICARE
135213MedicaidSC
GP6882OtherSCMEDICAID GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070410000749 SC Practitioner - Family Practice 8426943473 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5325 Appian Way
Charleston, SC 29420-7234
Phone (843) 695-6071

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Palmetto Primary Care Physicians, LLC Family Medicine Current Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine Current Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine Current Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine CurrentSince May 20, 2017 Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine Current Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine Current Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine CurrentSince May 20, 2017 Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine Past Accepting new patients

Locations

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

5325 Appian Way
Charleston, SC 29420
Phone (843) 552-0400

776 Daniel Ellis Dr
Ste 1B
Charleston, SC 29412
Phone (843) 795-0300

899 Island Park Dr
Ste 200
Daniel Island, SC 29492
Phone (843) 797-5050

110 Springhall Dr
Ste A
Goose Creek, SC 29445
Phone (843) 973-8503

7 S Alliance Dr
Ste 201A
Goose Creek, SC 29445
Phone (843) 553-4383

7 S Alliance Dr
Ste 211B
Goose Creek, SC 29445
Phone (843) 553-4383

115 Executive Pkwy
Moncks Corner, SC 29461
Phone (843) 761-2815

401 N Live Oak Dr
Ste B
Moncks Corner, SC 29461
Phone (843) 761-7884

2500 Elms Center Rd
North Charleston, SC 29406
Phone (763) 348-2075

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

201 Oakbrook Ln
Ste 255
Summerville, SC 29485
Phone (843) 851-2000

201 Sigma Dr
Ste 100
Summerville, SC 29486
Phone (843) 820-3397

300 W 4th North St
Summerville, SC 29483
Phone (843) 285-7515

435 N Cedar St
Summerville, SC 29483
Phone (843) 873-1592

507 N Laurel St
Summerville, SC 29483
Phone (843) 875-0600

809 N Cedar St
Summerville, SC 29483
Phone (843) 871-9440

Interoperability endpoints

  • Direct secure messaging: john.redwine@ppcp1.eclinicaldirectplus.com

Organizations & group practices 8

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1548227101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530062",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303530062",
            "telephone_number": "843-695-6071",
            "fax_number": "843-569-5879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 APPIAN WAY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29420",
            "telephone_number": "843-552-0400",
            "fax_number": "843-552-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDWINE",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "13521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "060041439",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135213",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "GP6882",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.