Roper Saint Francis Physicians Network
Organization Active NPI Addiction Psychiatry Physician · Charleston, SC
NPI 1679950281 · NPPES record last updated Mar 11, 2024
Key facts
- NPI
- 1679950281
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Addiction Psychiatry Physician 2084P0802X
- Legal business name
- ROPER SAINT FRANCIS PHYSICIANS NETWORK
- Practice address
- 2097 Henry Tecklenburg Dr Ste 211W
Charleston, SC 29414 - Phone
- (843) 958-2555
- Fax
- (843) 402-1961
- NPI assigned
- May 4, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Robert R. Oliverio Jr., MD
- Title
- VP/Ceo Rsfpp
- Phone
- (843) 724-2903
Corporate family (same tax ID) 24
Practitioners 7
-
Alyssa Marie Braxton, M.D.
-
Shelby Marie Carter, LISW
-
Sarah Brice Russo, MD, PHD
-
John M Walters, LISW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090528000405 | SC | Part B Supplier - Clinic/Group Practice | 5193874824 |
Receives reassigned benefits from 837 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Roper St Francis Physicians
Locations
2097 Henry Tecklenburg Dr
Ste 211W
Charleston, SC 29414
Phone (843) 958-2555
9500 Dorchester Rd
Ste 362
Summerville, SC 29485
Phone (843) 212-8080
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | SC | ||
| Addiction Psychiatry Physician |
2084P0802X | SC | Yes |
Addresses
Primary practice location
2097 Henry Tecklenburg Dr Ste 211W
Charleston, SC 29414
Mailing address
PO Box 751649
Charlotte, NC 28275-1649
Phone (888) 472-0043
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 614387336 | Other | SC | DOL |
| 280 | Other | SC | BCBS SC AND BLUECHOICE SURFFIX |
| GP6953 | Medicaid | SC |
Other names
- Roper St. Francis Physician Partners Behavioral Medicine
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other |
Other providers in Charleston, SC
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
All providers in Charleston, SC · Addiction Psychiatry Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.