Michelle McCollam, PA-C
Individual provider Active NPI Physician Assistant · Montgomery, WV
NPI 1700955564 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1700955564
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 01025 (WV)
- Practice address
- 401 6TH Ave
Suite 102
Montgomery, WV 25136-2116 - Phone
- (304) 442-8381
- NPI assigned
- Nov 7, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Charleston ENT Associates, LLC
Practice addresses (Care Compare)
10 Arley Way
Suite 101
Bluffton, SC 29910-4883
Phone (843) 682-3955
1231 Ribaut Rd
Beaufort, SC 29902-6147
Phone (843) 525-6622
1849 Savage Rd
Charleston, SC 29407-4726
Phone (843) 766-7103
2295 Henry Tecklenburg Dr
Charleston, SC 29414-7801
Phone (843) 766-7103
23 Main St
Suite 201
Hilton Head, SC 29926-6607
Phone (843) 682-3955
Hospital & facility affiliations
- Beaufort County Memorial Hospital
- Novant Health Hilton Head Medical Center
- Coastal Carolina Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.33 of 100
- Quality
- 86.06
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230122000052 | SC | Practitioner - Physician Assistant | 3779954136 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4494 | SC | MD | Speech-Language Pathologist |
| 01025 | WV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charleston ENT Associates, LLC | Current |
Accepting new patients | |
| Riverside Medical Group PLLC | Past |
Accepting new patients |
Locations
1231 Ribaut Rd
Beaufort, SC 29902
Phone (843) 525-6622
2295 Henry Tecklenburg Dr
Charleston, SC 29414
1849 Savage Rd
Charleston, SC 29407
Phone (843) 576-2600
Interoperability endpoints
- michelle.mccollam.p1@direct.entap.nextgenshare.com
- https://api.platform.athenahealth.com/7580/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 01025 | WV | Yes |
Addresses
Primary practice location
401 6TH Ave
Suite 102
Montgomery, WV 25136-2116
Mailing address
PO Box 30
Montgomery, WV 25136-0030
Phone (304) 442-8381
Other providers in Montgomery, WV
- Vicki Jean Legg
- Tyler Charles Lewis
- Alice Lee Lockman
- Willard Truman Long Jr.
- Bradley Gilbert Marple
- James David Miller
- Brook Mills
- Saghir Ur Rehman Mir
- Jazmyn Mitchell
- Montgomery Gen Cahgrp
All providers in Montgomery, WV · Physician Assistant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.
- Order and Referring (CMS).
- 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.