Individual provider Active NPI

Timothy Jeremiah Horgan, DO

  • Pediatrics Physician
  • Charleston, SC
National Provider Identifier
1790166726
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
LL37687 Issued in SC
Practice address
171 Ashley Ave
Charleston, SC 29425-5529
Phone
(843) 792-1414
NPI assigned
Jun 16, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0102205143 VA
Pediatrics Physician 208000000X 34.014111 OH
Pediatrics Physician 208000000X LL37687 SC Primary

Addresses

Primary practice location

171 Ashley Ave
Charleston, SC 29425-5529

Mailing address

PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200

Other practice location 1

14 Medical Park, Ste 400
Pediatric Outpatient Center
Columbia, SC 29203
Phone (803) 434-6155

Other practice location 2

88 Medical Group
4881 Sugar Maple Drive, Bldg 830
Wright Patterson AFB, OH 45433-5529
Phone (937) 257-4784

Other practice location 3

3333 W Tech Rd
Miamisburg, OH 45342-0955
Phone (937) 641-5725

Other practice location 4

8501 Old Troy Pike
Huber Heights, OH 45424-1054
Phone (937) 641-4360

Other identifiers 1

IdentifierTypeStateIssuer
0376803MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220729002934 SC Practitioner - Pediatric Medicine 7012203029 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34.014111OHMDPediatrics Physician
0102205143VAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol Pediatrics CurrentSince Jul 1, 2022 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Jul 1, 2022 Accepting new patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients
Medical University Hospital Authority Past Accepting new patients

Locations

135 Rutledge Ave
Charleston, SC 29425
Phone (803) 569-1757

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

2250 Mall Dr
North Charleston, SC 29406
Phone (843) 876-0199

Interoperability endpoints

  • Direct secure messaging: thorgan403048@direct.musc.edu

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1790166726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294255529",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Medical Park, Ste 400",
            "address_2": "Pediatric Outpatient Center",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "29203",
            "country_code": "US",
            "telephone_number": "803-434-6155",
            "fax_number": "803-434-6979",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "88 Medical Group",
            "address_2": "4881 Sugar Maple Drive, Bldg 830",
            "address_purpose": "LOCATION",
            "city": "Wright Patterson AFB",
            "state": "OH",
            "postal_code": "454335529",
            "country_code": "US",
            "telephone_number": "937-257-4784",
            "fax_number": "937-565-1091",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 W Tech Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453420955",
            "country_code": "US",
            "telephone_number": "937-641-5725",
            "fax_number": "937-350-3050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8501 Old Troy Pike",
            "address_purpose": "LOCATION",
            "city": "Huber Heights",
            "state": "OH",
            "postal_code": "454241054",
            "country_code": "US",
            "telephone_number": "937-641-4360",
            "fax_number": "937-641-3791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HORGAN",
        "first_name": "TIMOTHY",
        "middle_name": "JEREMIAH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-16",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102205143",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "34.014111",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL37687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0376803",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "171 Ashley Ave",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294255529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.