NPIMap

Individual provider Active NPI

Michael M Samiratedu, DO

  • Nephrology Physician
  • North Charleston, SC
National Provider Identifier
1750801288
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
DO83825 Issued in SC
Practice address
3815 Faber Place Dr
North Charleston, SC 29405-8533
Phone
(843) 767-9312
Fax
(843) 767-9313
NPI assigned
Jun 26, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X DO83825 SC Primary

Addresses

Primary practice location

3815 Faber Place Dr
North Charleston, SC 29405-8533

Mailing address

3815 Faber Place Dr
North Charleston, SC 29405-8533
Phone (843) 767-9312

Other identifiers 1

IdentifierTypeStateIssuer
838260MedicaidSC

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
I20220919000807 SC Practitioner - Internal Medicine 6406120260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Nephrology Associates, LLCGroup PAC ID 9638138209, 18 clinicians

Practice addresses (Care Compare)

149 Saint James Ave
Goose Creek, SC 29445-2923
Phone (843) 767-9312

3815 Faber Place Dr
North Charleston, SC 29405-8533
Phone (843) 767-9260

Hospital & facility affiliations

  • DaVita Charles Towne Dialysis Dialysis facility, Charleston, SC, CCN 422632
  • Fresenius Kidney Care Carnes Crossroads Dialysis facility, Summerville, SC, CCN 422681
  • Fresenius Medical Care Low Country Home Dialysis Dialysis facility, Summerville, SC, CCN 422658
  • Fresenius Medical Care Charleston County Dialysis facility, Mount Pleasant, SC, CCN 422630
  • FMC Mt Pleasant Dialysis Center Dialysis facility, Mount Pleasant, SC, CCN 422601
  • Roper Hospital Hospital, Charleston, SC, CCN 420087
  • Trident Medical Center Hospital, Charleston, SC, CCN 420079
  • Roper St Francis Hospital-Berkeley Inc Hospital, Summerville, SC, CCN 420110
  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065
  • Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104
  • Musc Healt Rehabilitation Hospital Inpatient rehabilitation facility, North Charleston, SC, CCN 423027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO83825SCMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Nephrology Associates, LLC Single Specialty CurrentSince Jul 22, 2022 Accepting new patients

Locations

149 Saint James Ave
Goose Creek, SC 29445
Phone (843) 724-3456

3815 Faber Place Dr
North Charleston, SC 29405
Phone (843) 767-9260

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/0900078

Organizations & group practices 1

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 9

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": "1498435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1750801288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 FABER PLACE DR",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294058533",
            "telephone_number": "843-767-9312",
            "fax_number": "843-767-9313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 FABER PLACE DR",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294058533",
            "telephone_number": "843-767-9312",
            "fax_number": "843-767-9313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMIRATEDU",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-26",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "SC",
            "license": "DO83825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "838260",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

Verify at the official NPI Registry.