NPIMap

Organization Active NPI

East Cooper Physician Group LLC

Doing business as Revela Assisted Living

  • Internal Medicine Physician
  • Mount Pleasant, SC
National Provider Identifier
1790546232
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EAST COOPER PHYSICIAN GROUP LLC
Doing business as
Revela Assisted Living
Practice address
1047 Anna Knapp Blvd
Mt Pleasant, SC 29464-3146
Phone
(843) 884-7977
NPI assigned
Jan 22, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Authorized official

Name
Doreatha Rogers
Title
RCS Manager
Phone
(980) 302-7992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1047 Anna Knapp Blvd
Mt Pleasant, SC 29464-3146

Mailing address

PO Box 37642
Belfast, ME 04915-1218

Other names 1

  • Revela Assisted Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
East Cooper Physician Group LLC49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

Organizations that report the same tax identification number in the National Provider Directory.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1790546232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37642",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049151218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1047 ANNA KNAPP BLVD",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643146",
            "telephone_number": "843-884-7977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST COOPER PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "DOREATHA",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "980-302-7992"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revela Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.