NPIMap

Organization Active NPI

Oakbrook Pediatrics, PA

  • Pediatrics Physician
  • Summerville, SC
National Provider Identifier
1760456909
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
OAKBROOK PEDIATRICS, PA
Practice address
1801 Trolley Rd
Ste 202
Summerville, SC 29485-8283
Phone
(843) 871-2588
Fax
(843) 871-1664
NPI assigned
Feb 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Mary Kate Tillman, M.D.NPI 1669451092
Title
President
Phone
(843) 871-2588

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1801 Trolley Rd
Ste 202
Summerville, SC 29485-8283

Mailing address

1801 Trolley Rd
Ste 202
Summerville, SC 29485-8283
Phone (843) 871-2588

National Provider Directory

National Provider Directory

Locations

1801 Trolley Rd
Ste 202
Summerville, SC 29485
Phone (843) 871-2588

Practitioners & affiliated clinicians

Practitioners 11

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": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760456909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 TROLLEY RD",
            "address_2": "STE 202",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294858283",
            "telephone_number": "843-871-2588",
            "fax_number": "843-871-1664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 TROLLEY RD",
            "address_2": "STE 202",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294858283",
            "telephone_number": "843-871-2588",
            "fax_number": "843-871-1664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKBROOK PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "MARY KATE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-871-2588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.