NPIMap

Organization Active NPI

Vitality Medical Centers of Charleston Inc

  • Physical Medicine & Rehabilitation Physician
  • North Charleston, SC
National Provider Identifier
1750820510
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
VITALITY MEDICAL CENTERS OF CHARLESTON INC
Practice address
2679 Lake Park Dr
North Charleston, SC 29406-9100
Phone
(843) 480-0855
NPI assigned
Feb 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Authorized official

Name
Mr. Jason B Farmer
Title
Owner
Phone
(803) 244-9212

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

2679 Lake Park Dr
North Charleston, SC 29406-9100

Mailing address

PO Box 7227
West Columbia, SC 29171-7227
Phone (803) 244-9212

Other names 1

  • VMC of Charleston Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170425002199 SC Part B Supplier - Clinic/Group Practice 2668759861 Receives reassigned benefits from 5 practitioners
Practice locations: North Charleston, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1750820510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7227",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291717227",
            "telephone_number": "803-244-9212",
            "fax_number": "803-708-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2679 LAKE PARK DR",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069100",
            "telephone_number": "843-480-0855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY MEDICAL CENTERS OF CHARLESTON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "FARMER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-244-9212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VMC of Charleston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VMC of Charleston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.