NPIMap

Individual provider Active NPI

David Paul Rodgers, MD

  • Family Medicine Physician
  • Bonneau, SC
National Provider Identifier
1619934346
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11879 Issued in SC
Practice address
1401 Main St
Bonneau, SC 29431-5013
Phone
(843) 825-3404
Fax
(843) 825-3407
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 11879 SC Primary

Addresses

Primary practice location

1401 Main St
Bonneau, SC 29431-5013

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
118795MedicaidSC
080096524OtherSCRR MEDICARE

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
I20031120000535 SC Practitioner - Family Practice 3779487921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1401 Main St
Bonneau, SC 29431-5013
Phone (843) 695-6071

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11879SCMDPhysical Therapist

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 CurrentSince Mar 24, 2003 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 Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Trident Medical Services D/B/a Trident Senior Health Center 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

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

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

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

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

Interoperability endpoints

  • Direct secure messaging: david.rodgers@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": "1619934346",
    "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": "1401 MAIN ST",
            "city": "BONNEAU",
            "state": "SC",
            "postal_code": "294315013",
            "telephone_number": "843-825-3404",
            "fax_number": "843-825-3407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODGERS",
        "first_name": "DAVID",
        "middle_name": "PAUL",
        "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": "11879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118795",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080096524",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonneau, SC

Sources for this page

Verify at the official NPI Registry.