Individual provider Active NPI

Brooke Victoria Hisrich, MD

  • Internal Medicine Physician
  • Charleston, SC
National Provider Identifier
1790414480
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
LL87753 Issued in SC
Practice address
169 Ashley Ave Room 202 Main Hospital, MSC 333
Charleston, SC 29425
Phone
(843) 792-0435
NPI assigned
Jun 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X LL87753 SC
Internal Medicine Physician 207R00000X LL87753 SC Primary

Addresses

Primary practice location

169 Ashley Ave Room 202 Main Hospital, MSC 333
Charleston, SC 29425

Mailing address

169 Ashley Ave Room 202 Main Hospital, MSC 333
Charleston, SC 29425
Phone (843) 792-0435

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hisrich@musc.edu

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
I20221206001824 SC Order and Referring Only - Internal MedicinePractitioner - Pediatric MedicinePractitioner - Internal Medicine 1658740113

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL87753SCMDPediatrics Physician

NPI Registry JSON

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1790414480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE ROOM 202 MAIN HOSPITAL, MSC 333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29425",
            "telephone_number": "843-792-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE ROOM 202 MAIN HOSPITAL, MSC 333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29425",
            "telephone_number": "843-792-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HISRICH",
        "first_name": "BROOKE",
        "middle_name": "VICTORIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL87753",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL87753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hisrich@musc.edu",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "169 Ashley Ave Room 202 Main Hospital, MSC 333",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.