NPIMap

Individual provider Active NPI

Tracy Raphaela Neilan, NP

  • Family Nurse Practitioner
  • Ladson, SC
National Provider Identifier
1639462591
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
17574 Issued in SC
Practice address
3495 Iron Horse Rd
Ladson, SC 29456-4319
Phone
(843) 793-5970
NPI assigned
May 25, 2011
Last updated
Jan 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 17574 SC Primary
Family Nurse Practitioner 363LF0000X F336742-1 NY

Addresses

Primary practice location

3495 Iron Horse Rd
Ladson, SC 29456-4319

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
NP7662MedicaidSC

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
I20210818000308 SC Practitioner - Nurse Practitioner 0244551646 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F336742-1NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol CurrentSince Sep 12, 2022 Accepting new patients
Palmetto Primary Care Physicians, LLC Current Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Jan 24, 2022 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Jan 24, 2022 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Sep 12, 2022 Accepting new patients
Mount Sinai School of Medicine PastSince Apr 8, 2019 Accepting new patients

Locations

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

3495 Iron Horse Rd
Ladson, SC 29456
Phone (843) 793-5970

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

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 10

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": "1306281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1639462591",
    "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": "874-569-5881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3495 IRON HORSE RD",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294564319",
            "telephone_number": "843-793-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEILAN",
        "first_name": "TRACY",
        "middle_name": "RAPHAELA",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-25",
        "last_updated": "2022-01-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "17574",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F336742-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP7662",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ladson, SC

Sources for this page

Verify at the official NPI Registry.