NPIMap

Organization Active NPI

Old Mission Wound Care South Carolina LLC

  • Specialist
  • Traverse City, MI
National Provider Identifier
1699514067
Registry record updated Aug 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
OLD MISSION WOUND CARE SOUTH CAROLINA LLC
Practice address
1989 Kroupa Rd
Traverse City, MI 49686-9759
Phone
(231) 260-4622
NPI assigned
May 23, 2024
Last updated
Aug 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2024

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

Authorized official

Name
Dr. Christopher Paul Mason, DONPI 1073838017
Title
Owner
Phone
(231) 260-4622

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1989 Kroupa Rd
Traverse City, MI 49686-9759

Mailing address

225 Matlage Way Unit 31
Sugar Land, TX 77487-0807
Phone (231) 260-4622

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240919000070 SC Part B Supplier - Clinic/Group Practice 0648711556 Receives reassigned benefits from 12 practitioners
Practice locations: Summerville, SC

National Provider Directory

National Provider Directory

Locations

700 Nexton Square Dr
Ste 138
Summerville, SC 29486

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1716422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724457600000",
    "number": "1699514067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MATLAGE WAY UNIT 31",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774870807",
            "telephone_number": "231-260-4622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1989 KROUPA RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496869759",
            "telephone_number": "231-260-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MISSION WOUND CARE SOUTH CAROLINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-08-24",
        "certification_date": "2024-08-24",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-260-4622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2024; 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.