Michael S Otruba, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

000312 Issued in SC

Practice address

161 Two Pond Loop
Ladson, SC 29456-6917

Phone

(843) 475-1020

NPI assigned

Dec 14, 2005

Last updated

Aug 1, 2019By 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

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.

• Palmetto Rehab of Charleston LLC

  • Physical Therapy Clinic/Center
  • Summerville, SC
  • NPI 1881663300
  NPD (past)

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1649255316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 TWO POND LOOP",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294566917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 TWO POND LOOP",
            "city": "LADSON",
            "state": "SC",
            "postal_code": "294566917",
            "telephone_number": "843-475-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTRUBA",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "000312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003123",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• O.P.a.L.S. Health, LLC
• Heather Oaks, LPN
• Lauren Orosz, PA
• Kara E Orr, PT
• Katherine Orza, SLP
• Kirstyn Owen, ATS
• Tony Lamar Owens Jr., MD
• Palmetto Primary Care Physicians, LLC
• Palmetto Primary Care Physicians, LLC (Palmetto Advanced Therapy Services LLC)
• Palmetto Primary Care Physicians, LLC

• Internal Medicine Physician in Ladson, SC
• Providers in Ladson, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.