Active NPI
Mary E. Trephan, PA-C
- Physician Assistant
- Summerville, SC
National Provider Identifier
1659806446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2644
- Practice address
- 1114 N Main St
Summerville, SC 29483-7326 - Phone
- (843) 212-8070
- Fax
- (843) 212-8071
- NPI assigned
- Apr 29, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2644 | SC | Primary |
Addresses
Primary practice location
1114 N Main St
Summerville, SC 29483-7326
Mailing address
PO Box 751649
Charlotte, NC 28275-1649
Phone (843) 789-1620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3767PA | Medicaid | SC |
Other names 1
- Mary E. Rumble
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2644 | SC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559520000000",
"number": "1659806446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751649",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751649",
"telephone_number": "843-789-1620",
"fax_number": "843-724-2440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1114 N MAIN ST",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294837326",
"telephone_number": "843-212-8070",
"fax_number": "843-212-8071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TREPHAN",
"first_name": "MARY",
"middle_name": "E.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-29",
"last_updated": "2019-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "PA2644",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3767PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "RUMBLE",
"middle_name": "E.",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
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- Stewart Alan Trimble, MD
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; 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.