NPIMap

Organization Active NPI

Medical University Hospital Authority

  • Rural Health Clinic/Center
  • Lake City, SC
National Provider Identifier
1780293290
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Practice address
148 Sauls St Ste 3
Lake City, SC 29560-2677
Phone
(843) 699-9183
NPI assigned
Jul 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

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

Authorized official

Name
Karyn Rae
Title
Chief
Phone
(843) 876-1344

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

148 Sauls St Ste 3
Lake City, SC 29560-2677

Mailing address

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

Other names 1

  • MUSC Health Primary Care Lake City Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201230002311 SC Part A Provider - Rural Health Clinic 1557268950 Practice locations: Lake City, SC

Rural health clinic certification: CCN 423486

Legal name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Doing business as
MUSC HEALTH PRIMARY CARE LAKE CITY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 24, 2021
Last certification
Feb 24, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Dec 29, 2020 in SC
Enrollment address
148 Sauls St Ste 3
Lake City, SC 29560-2677
Related CCNs
420019

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

National Provider Directory

National Provider Directory
Tax ID family
Medical Univ Hosp Authority71 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

Locations

148 Sauls St
Ste C
Lake City, SC 29560
Phone (843) 374-3621

148 Sauls St
Ste 3
Lake City, SC 29560
Phone (843) 374-3621

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Lisa M Goodlett Individual Corporate OfficerCfo Mar 1, 2019
Sonya Floyd Individual W-2 Managing Employee Mar 1, 2019
Karyn Rae Individual Corporate DirectorChair, Payor Relations and Reimburs Mar 1, 2019
Patrick J Cawley Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2019 100%
Corporate OfficerCeo Mar 1, 2019

All facility ownership & control disclosures 11

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 Health Primary Care - Thurgood Marshall BlvdKingstree, SC, CCN 423448 Rural health clinic Operational/Managerial Control (100%) Dec 1, 2022
Musc Community PhysiciansBranchville, SC, CCN 423856 Rural health clinic Operational/Managerial Control (100%) Aug 1, 2021

Practitioners & affiliated clinicians

Practitioners 7

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": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663891200000",
    "number": "1780293290",
    "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": "148 SAULS ST STE 3",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602677",
            "telephone_number": "843-699-9183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL UNIVERSITY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-30",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "KARYN",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "843-876-1344"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 Lake City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake City, SC

Sources for this page

Verify at the official NPI Registry.