Ammon Waddell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4778 Issued in SC

Practice address

602 N Main St
Summerville, SC 29483-6627

Phone

(843) 881-4440

Fax

(843) 225-0110

NPI assigned

Jun 15, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT, SC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forefront Dermatology SCGroup PAC ID 3779471701, 650 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Mt Pleasant, SC
  • NPI 1295577922
  Medicare reassignment Care Compare group NPD
• University of Utah Community Physicians Group

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1467241554
  Medicare reassignment NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Columbus, OH
  • NPI 1063365385
  NPD
• University of Utah Community Physicians Group

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1124422126
  NPD
• Forefront Dermatology, S.C.

  • Dermatology Physician
  • Manitowoc, WI
  • NPI 1578515904
  NPD (past)
• Intermountain Pain Management and Injury, Inc,

  • Interventional Pain Medicine Physician
  • Taylorsville, UT
  • NPI 1972862605
  NPD (past)
• Intermountain Pain Solutions

  • Anesthesiology Physician
  • Taylorsville, UT
  • NPI 1528519089
  NPD (past)

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1780114348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N MAIN ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294836627",
            "telephone_number": "843-881-4440",
            "fax_number": "843-225-0110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "612 Seacoast Pkwy",
            "address_purpose": "LOCATION",
            "city": "Mt Pleasant",
            "state": "SC",
            "postal_code": "294648247",
            "country_code": "US",
            "telephone_number": "843-881-4440",
            "fax_number": "843-884-8540",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1814 CROWNE COMMONS WAY",
            "address_purpose": "LOCATION",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294554932",
            "country_code": "US",
            "telephone_number": "843-881-4440",
            "fax_number": "843-737-5288",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14490 Ocean Hwy",
            "address_purpose": "LOCATION",
            "city": "Pawleys Island",
            "state": "SC",
            "postal_code": "295854821",
            "country_code": "US",
            "telephone_number": "843-881-4440",
            "fax_number": "843-314-0785",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "AMMON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-15",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4778",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10420324-1206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awaddell476859@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "awaddell476859@direct.med.utah.edu",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vistelan, LLC
• Francy Yuliech Vivas Solarte, MD
• Jason Michael Vogt, PHARM.D
• Lauren Von Lehe
• Shannon Vorlick, CPNP
• Ryan Wade, MD
• Melissa Waggoner, PHD
• Shaylynn King Wagner
• Sara Anne Waite, FNP-C
• Wal-Mart Stores East LP

• Physician Assistant in Summerville, SC
• Providers in Summerville, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.