NPIMap

Organization Active NPI

PPCP Specialty Physicians, LLC

  • Neurology Physician
  • Summerville, SC
National Provider Identifier
1720693039
Registry record updated Feb 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
PPCP SPECIALTY PHYSICIANS, LLC
Practice address
5500 Front St Ste 230
Summerville, SC 29486-7735
Phone
(843) 569-1856
Fax
(843) 569-1879
NPI assigned
Sep 14, 2020
Last updated
Feb 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2022

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

Authorized official

Name
Terry Cunningham
Title
Ceo
Phone
(843) 695-6071

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X Primary

Addresses

Primary practice location

5500 Front St Ste 230
Summerville, SC 29486-7735

Mailing address

PO Box 530062
Atlanta, GA 30353-0062
Phone (843) 695-6071

Other identifiers 1

IdentifierTypeStateIssuer
GP9819MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170801001865 SC Part B Supplier - Clinic/Group Practice 2466723028 Receives reassigned benefits from 32 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charleston, SC; Summerville, SC; Mt Pleasant, SC; Moncks Corner, SC; Ladson, SC; Irmo, SC; Goose Creek, SC; Daniel Island, SC…

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646006400000",
    "number": "1720693039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530062",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303530062",
            "telephone_number": "843-695-6071",
            "fax_number": "843-569-5879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 FRONT ST STE 230",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294867735",
            "telephone_number": "843-569-1856",
            "fax_number": "843-569-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPCP SPECIALTY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-14",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-695-6071"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP9819",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; 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.