NPIMap

Individual provider Active NPI

Pongstorn Pitiranggon, MD

  • Specialist
  • Florence, SC
National Provider Identifier
1740272236
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
20141 Issued in SC
Practice address
514 S Dargan St
Suite H
Florence, SC 29506-2552
Phone
(843) 669-5956
Fax
(843) 669-2019
NPI assigned
Aug 19, 2005
Last updated
Jan 5, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 20141 SC Primary

Addresses

Primary practice location

514 S Dargan St
Suite H
Florence, SC 29506-2552

Mailing address

514 S Dargan St
Suite H
Florence, SC 29506-2552
Phone (843) 669-5956

Other identifiers 1

IdentifierTypeStateIssuer
T42219MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040331000946 SC Practitioner - NephrologyPractitioner - Internal Medicine 7315939352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pee Dee Nephrology LLPGroup PAC ID 6507853629, 9 clinicians

Practice addresses (Care Compare)

1100 E Cheves St
Florence, SC 29506-2708
Phone (843) 669-6694

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pee Dee Nephrology LLP Nephrology CurrentSince Nov 1, 2014 Accepting new patients
Advanced Nutrition Consultants Inc CurrentSince Nov 1, 2014 Accepting new patients
Musc Community Physicians Past Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc. Past Accepting new patients

Locations

1100 E Cheves St
Florence, SC 29506
Phone (843) 669-6694

Interoperability endpoints

  • Direct secure messaging: ppitiranggon24150@direct.acumenmd.com
  • Direct secure messaging: ppitiranggon273008@direct.musc.edu
  • Direct secure messaging: ppitiranggon28363@directmcleodehealth.org

Organizations & group practices 4

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

Hospital & facility affiliations 8

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1740272236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 S DARGAN ST",
            "address_2": "SUITE H",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062552",
            "telephone_number": "843-669-5956",
            "fax_number": "843-669-2019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 S DARGAN ST",
            "address_2": "SUITE H",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062552",
            "telephone_number": "843-669-5956",
            "fax_number": "843-669-2019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITIRANGGON",
        "first_name": "PONGSTORN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "20141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T42219",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.