Organization Active NPI

Athena Consulting LLC

  • Internal Medicine Physician
  • North Charleston, SC
National Provider Identifier
1679316889
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ATHENA CONSULTING LLC
Practice address
3842 Leeds Ave Unit C
North Charleston, SC 29405-7460
Phone
(843) 747-6634
NPI assigned
Jun 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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

Authorized official

Name
Tyler Stout
Title
Manager
Phone
(337) 315-7927

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

3842 Leeds Ave Unit C
North Charleston, SC 29405-7460

Mailing address

3842 Leeds Ave Unit C
North Charleston, SC 29405-7460
Phone (843) 747-6634

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240724000760 SC Part B Supplier - Clinic/Group Practice 0345786513 Receives reassigned benefits from 6 practitioners
Practice locations: North Charleston, SC

National Provider Directory

National Provider Directory

Locations

3842 Leeds Ave
Unit C
North Charleston, SC 29405
Phone (843) 747-6634

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1718409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762128000000",
    "number": "1679316889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3842 LEEDS AVE UNIT C",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294057460",
            "telephone_number": "843-747-6634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3842 LEEDS AVE UNIT C",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294057460",
            "telephone_number": "843-747-6634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENA CONSULTING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-15",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "337-315-7927"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.