NPIMap

Organization Active NPI

Medical University Hospital Authority

Doing business as MUSC Health Primary Care - Thurgood Marshall Blvd

  • Rural Health Clinic/Center
  • Kingstree, SC
National Provider Identifier
1770219412
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Doing business as
MUSC Health Primary Care - Thurgood Marshall Blvd
Practice address
500 Thurgood Marshall Hwy Ste F
Kingstree, SC 29556-4143
Phone
(843) 792-1414
NPI assigned
Jul 26, 2022
Last updated
Oct 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Karyn Rae
Title
Chief Payor Relations and Reimburse
Phone
(843) 876-1344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

500 Thurgood Marshall Hwy Ste F
Kingstree, SC 29556-4143

Mailing address

PO Box 23467
New York, NY 10087-3467
Phone (843) 792-6200

Other names 1

  • MUSC Health Primary Care - Thurgood Marshall Blvd Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221215000953 SC Part A Provider - Rural Health Clinic 1557268950 Practice locations: Kingstree, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770219412. Details of each certification follow.

Rural health clinic certification: CCN 423448

Legal name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Doing business as
MUSC HEALTH PRIMARY CARE - THURGOOD MARSHALL BLVD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 23, 2012
Last certification
Dec 19, 2023
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Oct 31, 2022 in SC
Enrollment address
500 Thurgood Marshall Hwy
Ste F
Kingstree, SC 29556-4143
Related CCNs
420019

Facilities connected through Provider of Services related, parent or unit certification numbers.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2020040Medical University Hospital Authority Dba500 Thurgood Marshall Hwy, Kingstree, SC 29556Certificate of waiverDec 20, 2026

National Provider Directory

National Provider Directory
Tax ID family
Medical University Hospital71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Medical University Hospital Authority Organization, Charleston, SC For-profit Operational/Managerial Control Dec 1, 2022 100%
Lisa M Goodlett Individual Corporate OfficerCfo Oct 31, 2022 100%
Sonya Floyd Individual W-2 Managing Employee Oct 31, 2022 100%
Karyn Rae Individual Corporate Director Oct 31, 2022 100%
Patrick J Cawley Individual Corporate OfficerCeo Oct 31, 2022 100%

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tidelands Waccamaw Community HospitalMurrells Inlet, SC, CCN 420098 Hospital Operational/Managerial Control Oct 1, 2025
Tidelands Georgetown Memorial HospitalGeorgetown, SC, CCN 420020 Hospital Operational/Managerial Control Oct 1, 2025
Musc Health Lancaster Medical CenterLancaster, SC, CCN 429803 Hospital Operational/Managerial Control (100%) Mar 1, 2019
Musc Health Lancaster Rehabilitation CenterLancaster, SC, CCN 42T036 Hospital Operational/Managerial Control (100%) Mar 1, 2019
Tidelands Georgetown Memorial HospitalGeorgetown, SC, CCN 42U020 Hospital Operational/Managerial Control Oct 1, 2025
Tidelands Health Family Medicine at GeorgetownGeorgetown, SC, CCN 428958 Rural health clinic Operational/Managerial Control Oct 1, 2020
Tidelands Health Family Medicine at HemingwayHemingway, SC, CCN 423859 Rural health clinic Operational/Managerial Control Oct 1, 2025
Tidelands Health Family MedicineAndrews, SC, CCN 423970 Rural health clinic Operational/Managerial Control Oct 1, 2025
Tidelands Health Family Medicine at Pawleys IslandPawleys Island, SC, CCN 423870 Rural health clinic Operational/Managerial Control Oct 1, 2025
Musc Community PhysiciansBranchville, SC, CCN 423856 Rural health clinic Operational/Managerial Control (100%) Aug 1, 2021

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 1

DateEventCounterparty
Dec 1, 2022 Change of OwnershipThis provider was the buyer Williamsburg Regional Health CenterCCN 423448, SC, NPI 1033413323

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1658793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1770219412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23467",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873467",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 THURGOOD MARSHALL HWY STE F",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295564143",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL UNIVERSITY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "CHIEF PAYOR RELATIONS AND REIMBURSE",
        "authorized_official_telephone_number": "843-876-1344"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MUSC Health Primary Care - Thurgood Marshall Blvd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingstree, SC

Sources for this page

Verify at the official NPI Registry.