Shane Wilburn, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

89 Old Trolley Rd Ste 102
Summerville, SC 29485-4951

Phone

(854) 206-5513

Fax

(854) 246-8965

NPI assigned

Feb 7, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Palmetto Primary Care Physicians LLCGroup PAC ID 4880508068, 148 clinicians

Carolina Grace CounselingGroup PAC ID 1052788890, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Roper Hospital Hospital, Charleston, SC, CCN 420087

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shane.wilburn@ppcp1.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Grace Counseling

  • Clinical Social Worker
  • Summerville, SC
  • NPI 1356098370
  Medicare reassignment Care Compare group
• Palmetto Primary Care Physicians, LLC

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1073234928
  Medicare reassignment Care Compare group
• Palmetto Primary Care Physicians, LLC

  • Family Medicine Physician
  • Moncks Corner, SC
  • NPI 1184663007
  NPD
• Palmetto Primary Care Physicians, LLC

  • Family Medicine Physician
  • Summerville, SC
  • NPI 1366123739
  NPD
• Palmetto Primary Care Physicians, LLC

  • Family Medicine Physician
  • Bonneau, SC
  • NPI 1659311165
  NPD
• Palmetto Primary Care Physicians, LLC

  • Family Medicine Physician
  • Summerville, SC
  • NPI 1265690382
  NPD (past)
• Palmetto Primary Care Physicians, LLC

  • Audiologist
  • Ladson, SC
  • NPI 1982175451
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Roper Hospital, Inc

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1962472860
  Care Compare affiliation

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1669178075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 ROWBOAT RD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294866900",
            "telephone_number": "419-689-2923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 OLD TROLLEY RD STE 102",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294854951",
            "telephone_number": "854-206-5513",
            "fax_number": "854-246-8965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBURN",
        "first_name": "SHANE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-07",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Wical
• Keith Stanley Wickizer, D.M.D., M.S., A.B.O.
• William Wier
• Laura Wierichs, PA
• Kristen Farmer Wiggins
• Kailyn M Wilcox, M.D.
• Virginia Cuthbert Wilder, M. ED.
• Amy Wilkerson, LMT
• Amy Beth Wilkerson, FNP
• Stephanie Lynn Wilkie, LPCA

• Physician Assistant in Summerville, SC
• Providers in Summerville, 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 Apr 22, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.