Southern Palmetto Primary Care LLC

Key facts

NPI: 1700523347
Entity type: Organization (NPI type 2)
Primary specialty: Family Nurse Practitioner 363LF0000X
Legal business name: SOUTHERN PALMETTO PRIMARY CARE LLC
Practice address: 503 Chester Ave Ste C
Great Falls, SC 29055-1207
Phone: (803) 482-5904
NPI assigned: May 16, 2022
Organization subpart: No

Authorized official

Name: Kristina Starnes, FNP NPI 1548670532
Title: Owner
Phone: (803) 287-7019

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Kristina Starnes, APRN Family Nurse Practitioner · Great Falls, SC · NPI 1548670532

Medicare reassignment NPD Authorized official FAMILY · SC
Megan Alexandria Wolff, DNP, APRN, FNP-BC Family Nurse Practitioner · Fort Mill, SC · NPI 1568114650

NPD (past) FAMILY

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
42D2266021	Southern Palmetto Primary Care 503 Chester Avenue, Suite C, Great Falls, SC 29055	Certificate of waiver	Aug 3, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in SC

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20220803002617	SC	Part B Supplier - Clinic/Group Practice	2567844889	Receives reassigned benefits from 1 practitioner Practice locations: Great Falls, SC

National Provider Directory

Locations

503 Chester Ave
#C
Great Falls, SC 29055
Phone (803) 482-5904

Interoperability endpoints

FHIR API: https://api.platform.athenahealth.com/26508/brand/1/csg/1/fhir/r4

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Nurse Practitioner Group: 193400000X SINGLE SPECIALTY GROUP	363LF0000X			Yes

Addresses

Primary practice location

503 Chester Ave Ste C
Great Falls, SC 29055-1207

Mailing address

503 Chester Ave Ste C
Great Falls, SC 29055-1207

Other providers in Great Falls, SC

All providers in Great Falls, SC · Family Nurse Practitioner 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 May 16, 2022. 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.
Medicare Care Compare provider data (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.