NPIMap

Organization Active NPI

Musc Community Physicians

Doing business as MUSC Health Primary Care - Bamberg

  • Rural Health Clinic/Center
  • Bamberg, SC
National Provider Identifier
1720784127
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MUSC COMMUNITY PHYSICIANS
Doing business as
MUSC Health Primary Care - Bamberg
Practice address
3488 Main Hwy
Bamberg, SC 29003-1865
Phone
(843) 792-1414
NPI assigned
Feb 7, 2023
Last updated
Apr 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Authorized official

Name
Karyn Rae
Title
Chief, Payor Relations
Phone
(843) 876-1344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

3488 Main Hwy
Bamberg, SC 29003-1865

Mailing address

PO Box 23321
New York, NY 10087-3321
Phone (843) 792-6200

Other names 1

  • MUSC Health Primary Care - Bamberg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230502003384 SC Part A Provider - Rural Health Clinic 6507260668 Practice locations: Bamberg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720784127. Details of each certification follow.

Rural health clinic certification: CCN 423818

Legal name
MUSC COMMUNITY PHYSICIANS
Doing business as
MUSC HEALTH PRIMARY CARE - BAMBERG
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 12, 1991
Last certification
Jan 5, 2022
Ownership / control type
2B
Most recent change of ownership
Apr 12, 2010 (3 total)
Organization structure
CorporationProprietary
Incorporated
Aug 1, 2021 in SC
Enrollment address
498 North St
Bamberg, SC 29003-1377

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0658527Musc Health Primary Care-Bamberg3488 Main Highway, Bamberg, SC 29003Provider-performed microscopySep 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Musc Community Physicians10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lisa M Goodlett Individual Corporate OfficerCfo Oct 2, 1966 100%
Sonya Floyd Individual W-2 Managing EmployeeManager Mar 1, 2023 100%
Karyn Rae Individual Corporate DirectorChief, Payor Relations and Reimburs Mar 1, 2023 100%

Practitioners & affiliated clinicians

Practitioners 1

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": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1720784127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23321",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873321",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3488 MAIN HWY",
            "city": "BAMBERG",
            "state": "SC",
            "postal_code": "290031865",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUSC COMMUNITY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "CHIEF, PAYOR RELATIONS",
        "authorized_official_telephone_number": "843-876-1344"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MUSC Health Primary Care - Bamberg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MUSC Health Primary Care - Bamberg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bamberg, SC

Sources for this page

Verify at the official NPI Registry.