NPIMap

Individual provider Active NPI

William Martin Tucker III, MD

  • Family Medicine Physician
  • Goose Creek, SC
National Provider Identifier
1790861409
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
26336 Issued in SC
Practice address
119 Springhall Dr
Goose Creek, SC 29445-5368
Phone
(843) 266-2520
Fax
(843) 553-4436
NPI assigned
Oct 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 26336 SC
Family Medicine Physician 207Q00000X 26336 SC Primary

Addresses

Primary practice location

119 Springhall Dr
Goose Creek, SC 29445-5368

Mailing address

PO Box 530062
Atlanta, GA 30353-0062
Phone (843) 695-6071

Other identifiers 1

IdentifierTypeStateIssuer
263360MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070614000492 SC Practitioner - Family Practice 7810095874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mercer University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 A Springhall Dr
Goose Creek, SC 29445-5335
Phone (843) 695-6071

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26336SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Palmetto Primary Care Physicians, LLC Family Medicine CurrentSince Jun 4, 2007 Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine CurrentSince Jun 4, 2007 Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine Current Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine Past Accepting new patients

Locations

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

3930 Devine St
Columbia, SC 29205
Phone (803) 227-5330

110 Springhall Dr
Ste A
Goose Creek, SC 29445
Phone (843) 973-8503

119 Springhall Dr
Goose Creek, SC 29445
Phone (843) 266-2520

2500 Elms Center Rd
North Charleston, SC 29406
Phone (763) 348-2075

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

201 Sigma Dr
Ste 100
Summerville, SC 29486
Phone (843) 820-3397

Interoperability endpoints

  • Direct secure messaging: william.tucker@ppcp1.eclinicaldirectplus.com

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1790861409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530062",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303530062",
            "telephone_number": "843-695-6071",
            "fax_number": "843-569-5879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SPRINGHALL DR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294455368",
            "telephone_number": "843-266-2520",
            "fax_number": "843-553-4436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "WILLIAM",
        "middle_name": "MARTIN",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "26336",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "26336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "263360",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goose Creek, SC

Sources for this page

Verify at the official NPI Registry.