Matthew Nicholas Kunkelman, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2209 Issued in SC

Practice address

187 Bunch Ford Rd
Holly Hill, SC 29059-8224

Phone

(803) 496-3312

Fax

(803) 496-7713

NPI assigned

Oct 28, 2014

Last updated

Jan 6, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Musc Community Physicians

  dba MUSC Community Physicians Specialty

  • Internal Medicine Physician
  • Bamberg, SC
  • NPI 1841878006
  Medicare reassignment NPD
• Edisto Regional Health Services Inc.

  • Pediatrics Physician
  • Orangeburg, SC
  • NPI 1285692681
  Medicare reassignment
• Edisto Regional Health Services Inc

  dba RMC Primary Care Bowman

  • Rural Health Clinic/Center
  • Bowman, SC
  • NPI 1922756352
  NPD
• Edisto Regional Health Services Inc.

  dba RMC Primary Care Branchville

  • Rural Health Clinic/Center
  • Branchville, SC
  • NPI 1487701157
  NPD
• Musc Community Physicians

  dba MUSC Health Primary Care - Bowman

  • Rural Health Clinic/Center
  • Bowman, SC
  • NPI 1225735772
  NPD
• Regional Medical Center of Orangeburg and Calhoun Counties

  dba RMC Pharmacy

  • Community/Retail Pharmacy
  • Orangeburg, SC
  • NPI 1467709881
  NPD (past)

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

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1629473012",
    "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": "803-395-4497",
            "fax_number": "803-395-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 BUNCH FORD RD",
            "city": "HOLLY HILL",
            "state": "SC",
            "postal_code": "290598224",
            "telephone_number": "803-496-3312",
            "fax_number": "803-496-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNKELMAN",
        "first_name": "MATTHEW",
        "middle_name": "NICHOLAS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-28",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "4173",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RHC",
            "identifier": "428926",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC012",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC151",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RHC",
            "identifier": "423828",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PC4116",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC020",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan H Jaques, DMD
• Jeffery Jones
• Tracy Judy
• Julia A Keefe, FNP
• Lauren Smoak Kinsey, LPN
• Troy Blakely Lamb
• Shaunette L Lloyd, MA CLINICAL COUNSELO
• Ashley Victoria Mack, PHARMD
• David Mickell, BA SOCIAL WORKER
• Musc Community Physicians (MUSC Health Primary Care - Holly Hill)

• Physician Assistant in Holly Hill, SC
• Providers in Holly Hill, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.