NPIMap

Individual provider Active NPI

Stacy W Weaver, P.A.

  • Physician Assistant
  • Orangeburg, SC
National Provider Identifier
1609127075
Registry record updated Apr 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1829 Issued in SC
Practice address
1619 Carolina Ave
Orangeburg, SC 29115-4939
Phone
(803) 537-7474
Fax
(803) 531-7457
NPI assigned
Sep 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2013

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 1829 SC Primary

Addresses

Primary practice location

1619 Carolina Ave
Orangeburg, SC 29115-4939

Mailing address

PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4561

Other identifiers 2

IdentifierTypeStateIssuer
GP5343MedicaidSC
018OtherSCBLUE CROSS BLUE SHIELD / BLUE CHOICE

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
I20121026000462 SC Practitioner - Physician Assistant 7719137835 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Carolina Surgical PAGroup PAC ID 0345599247, 3 clinicians

Practice addresses (Care Compare)

3045 Saint Matthews Rd
Orangeburg, SC 29118-1443
Phone (803) 747-7242

Hospital & facility affiliations

  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Lexington Medical Center Hospital, West Columbia, SC, CCN 420073

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1829SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Vascular & Vein Center, LLC CurrentSince Dec 1, 2025 Accepting new patients
Coastal Vascular and Vein Institute LLC PastSince Apr 16, 2023 Accepting new patients

Locations

1327 Ashley River Rd
Charleston, SC 29407
Phone (843) 300-3588

1327 Ashley River Rd
Ste B
Charleston, SC 29407
Phone (614) 591-4049

3045 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 665-2049

1229 Nexton Pkwy
Unit C
Summerville, SC 29486
Phone (843) 557-4551

Interoperability endpoints

  • Direct secure messaging: sweaver442630@direct.musc.edu
  • FHIR API: https://fhir4.healow.com/fhir/r4/AHDFBA

Organizations & group practices 3

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

Hospital & facility affiliations 7

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": "1348617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1609127075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161245",
            "telephone_number": "803-395-4561",
            "fax_number": "803-395-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 CAROLINA AVE",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154939",
            "telephone_number": "803-537-7474",
            "fax_number": "803-531-7457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "STACY",
        "middle_name": "W",
        "name_prefix": "Ms.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-26",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5343",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD / BLUE CHOICE",
            "identifier": "018",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

Verify at the official NPI Registry.