NPIMap

Individual provider Active NPI

Temisan L Etikerentse, MD

  • Internal Medicine Physician
  • Moncks Corner, SC
National Provider Identifier
1710986757
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20234 Issued in SC
Practice address
110 Executive Pkwy
Moncks Corner, SC 29461-3930
Phone
(843) 899-9099
Fax
(843) 899-9091
NPI assigned
Jul 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20234 SC Primary

Addresses

Primary practice location

110 Executive Pkwy
Moncks Corner, SC 29461-3930

Mailing address

783 Navigators Run
Mt. Pleasant, SC 29464-2829
Phone (843) 886-6729

Other identifiers 12

IdentifierTypeStateIssuer
JB021564OtherSCJUA
571134452OtherFEDERAL IN
GP3914MedicaidSC
20 20234OtherSCSTATE REGISTRATION
20234OtherSCMEDICAL LICENSE
202346MedicaidSC
562413454OtherSCSECONDARY TAX ID
562413454OtherFEDERAL IN
75767OtherSCSC PCF
9800859OtherNCMEDICAL LICENSE
GP3438MedicaidSC
JB021584OtherJUA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040427000113 SC Practitioner - Internal Medicine 0244126662 Reassigns benefits to 3 organizations
I20250902004119 NC Practitioner - Internal Medicine 0244126662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cogent Healthcare of North Carolina PCGroup PAC ID 7911954714, 66 clinicians
Cogent Healthcare of Georgia PCGroup PAC ID 2961483607, 252 clinicians
Liberty Doctors LLCGroup PAC ID 0840466017, 44 clinicians
Southeastern Hospitalist Services PCGroup PAC ID 3476855420, 301 clinicians

Practice addresses (Care Compare)

2460 Curtis Ellis Dr
Rocky Mount, NC 27804-2237
Phone (336) 538-7000

302 University Pkwy
Aiken, SC 29801-6302
Phone (803) 641-5000

418 Folly Rd
Ab
Charleston, SC 29412-2625
Phone (843) 225-8320

9330 Medical Plaza Dr
Charleston, SC 29406-9104
Phone (843) 847-4559

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20234SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Remedy Internal Medicine and Wellness Center P a Internal Medicine CurrentSince Jun 1, 2018 Accepting new patients
Liberty Doctors, LLC CurrentSince Jun 1, 2018 Accepting new patients
Cogent Healthcare of North Carolina, PC Internal Medicine CurrentSince May 29, 2025 Accepting new patients
Liberty Doctors LLC Current Accepting new patients
Hope Clinic LLC Internal Medicine Current Accepting new patients
Hope Clinic Current Accepting new patients
Hopeclinic Walterboro Past Accepting new patients
Americare Health, PC Internal Medicine Past Accepting new patients
Aiken Regional Medical Centers LLC Past Accepting new patients
Trident Medical Center, LLC Past Accepting new patients

Locations

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

2460 Curtis Ellis Dr
Rocky Mount, NC 27804
Phone (252) 443-8199

418 Folly Rd
#A
Charleston, SC 29412
Phone (843) 225-8320

110 Executive Pkwy
Moncks Corner, SC 29461
Phone (843) 899-9099

5880 Rivers Ave
North Charleston, SC 29406
Phone (843) 225-2374

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7359/brand/1/csg/1/fhir/r4
  • Direct secure messaging: tetikerentse69101@direct.musc.edu
  • Direct secure messaging: tetikerentse@libertydoctors.ssdirect.aprima.com
  • Direct secure messaging: temisan.etikerentse@securechartupload.net

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1710986757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "783 NAVIGATORS RUN",
            "city": "MT. PLEASANT",
            "state": "SC",
            "postal_code": "294642829",
            "telephone_number": "843-886-6729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EXECUTIVE PKWY",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294613930",
            "telephone_number": "843-899-9099",
            "fax_number": "843-899-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIKERENTSE",
        "first_name": "TEMISAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "20234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JUA",
            "identifier": "JB021564",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL IN",
            "identifier": "571134452",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3914",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE REGISTRATION",
            "identifier": "20 20234",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "20234",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202346",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECONDARY TAX ID",
            "identifier": "562413454",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL IN",
            "identifier": "562413454",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC PCF",
            "identifier": "75767",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "9800859",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3438",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JUA",
            "identifier": "JB021584",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

Verify at the official NPI Registry.