NPIMap

Individual provider Active NPI

Roger Polsky, NP-C

  • Family Nurse Practitioner
  • Florence, SC
National Provider Identifier
1578922332
Registry record updated Feb 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19955 Issued in SC
Practice address
805 Pamplico Hwy Ste A220
Florence, SC 29505-6056
Phone
(843) 674-1530
Fax
(843) 673-9098
NPI assigned
Feb 22, 2016
Last updated
Feb 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 19955 SC Primary

Addresses

Primary practice location

805 Pamplico Hwy Ste A220
Florence, SC 29505-6056

Mailing address

805 Pamplico Hwy Ste A220
Florence, SC 29505-6056
Phone (843) 674-1530

Other identifiers 1

IdentifierTypeStateIssuer
19955OtherSCSTATE LICENSE

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
I20160420000452 SC Practitioner - Nurse Practitioner 0941508212 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
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)

342 W Main St
Kingstree, SC 29556-3235
Phone (843) 355-3621

506 N St
Bamberg, SC 29003-1319
Phone (803) 245-6290

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
19955SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Family Care, Inc CurrentSince Mar 1, 2019 Accepting new patients
Carolina Family Care, Inc CurrentSince Mar 1, 2019 Accepting new patients
Musc Community Physicians CurrentSince Jan 30, 2022 Accepting new patients
Musc Community Physicians CurrentSince Jan 30, 2022 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients
Carolina Family Care, Inc Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1925 Hoffmeyer Rd
Florence, SC 29501
Phone (843) 661-4390

805 Pamplico Hwy
Ste 220
Florence, SC 29505

805 Pamplico Hwy
Ste 300
Florence, SC 29505
Phone (843) 679-2760

805 Pamplico Hwy
Ste A220
Florence, SC 29505
Phone (803) 664-9393

1341 Old Georgetown Rd
Ste C
Mt Pleasant, SC 29464
Phone (843) 884-2175

Organizations & group practices 6

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 9

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": "1456099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456099200000",
    "number": "1578922332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 PAMPLICO HWY STE A220",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056056",
            "telephone_number": "843-674-1530",
            "fax_number": "843-673-9098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 PAMPLICO HWY STE A220",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295056056",
            "telephone_number": "843-674-1530",
            "fax_number": "843-673-9098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLSKY",
        "first_name": "ROGER",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-22",
        "last_updated": "2016-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "19955",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.