Active NPI
Otis Edward Engelman, MD
- Family Medicine Physician
- Summerville, SC
National Provider Identifier
1730145509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 8516
- Practice address
- 1101 Old Trolley Rd
Ste. 100
Summerville, SC 29485-5293 - Phone
- (843) 875-0400
- Fax
- (843) 871-6700
- NPI assigned
- Apr 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 8516 | SC | Primary |
Addresses
Primary practice location
1101 Old Trolley Rd
Ste. 100
Summerville, SC 29485-5293
Mailing address
2418 Nnptc Circle
Goose Creek, SC 29445
Phone (843) 577-5011
Other practice location 1
2418 nnptc cIRCLE
Goose Creek, SC 29445
Phone (843) 577-5011 ext. 3100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85160 | Medicaid | SC | |
| 410013918 | Other | SC | MEDICARE RAIL ROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8516 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1730145509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2418 NNPTC CIRCLE",
"city": "GOOSE CREEK",
"state": "SC",
"postal_code": "29445",
"telephone_number": "843-577-5011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 OLD TROLLEY RD",
"address_2": "STE. 100",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294855293",
"telephone_number": "843-875-0400",
"fax_number": "843-871-6700"
}
],
"practiceLocations": [
{
"address_1": "2418 nnptc cIRCLE",
"address_purpose": "LOCATION",
"city": "Goose Creek",
"state": "SC",
"postal_code": "29445",
"country_code": "US",
"telephone_number": "843-577-5011 x3100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ENGELMAN",
"first_name": "OTIS",
"middle_name": "EDWARD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-21",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "8516",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "85160",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAIL ROAD",
"identifier": "410013918",
"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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.