NPIMap

Individual provider Active NPI

Wilmot R Gissendanner IV

  • Physician Assistant
  • Orangeburg, SC
National Provider Identifier
1578426441
Registry record updated Dec 6, 2025
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Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone
(803) 395-2871
NPI assigned
Dec 6, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X SC Primary

Addresses

Primary practice location

3000 Saint Matthews Rd
Orangeburg, SC 29118-1442

Mailing address

PO Box 23321
New York, NY 10087-3321

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Health Information Exchange (HIE)

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
I20260316003710 SC Practitioner - Physician Assistant 7416430616 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone (803) 395-3400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6280SCMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Mar 5, 2026 Accepting new patients
Musc Community Physicians CurrentSince Mar 5, 2026 Accepting new patients

Locations

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

Organizations & group practices 2

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 6

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": "1764979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764979200000",
    "number": "1578426441",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 SAINT MATTHEWS RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291181442",
            "telephone_number": "803-395-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GISSENDANNER",
        "first_name": "WILMOT",
        "middle_name": "R",
        "name_suffix": "IV",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-06",
        "last_updated": "2025-12-06",
        "certification_date": "2025-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3000 Saint Matthews Rd",
            "city": "Orangeburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291181442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

Verify at the official NPI Registry.