NPIMap

Organization Active NPI

Mt Pleasant Dermatology

  • Dermatology Physician
  • Mt. Pleasant, SC
National Provider Identifier
1821048828
Registry record updated Aug 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MT PLEASANT DERMATOLOGY
Practice address
570 Long Point Road
Suite 200
Mt. Pleasant, SC 29464
Phone
(843) 881-0320
Fax
(843) 881-5453
NPI assigned
May 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2025

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

Authorized official

Name
Ms. Tonya M Roper
Title
Credentialing Manager
Phone
(843) 936-7189

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X SC
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

570 Long Point Road
Suite 200
Mt. Pleasant, SC 29464

Mailing address

570 Long Point Road
Suite 200
Mt. Pleasant, SC 29464
Phone (843) 881-0320

Other identifiers 1

IdentifierTypeStateIssuer
GP0213MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040218000682 SC Part B Supplier - Clinic/Group Practice 6204721285 Receives reassigned benefits from 8 practitioners
Practice locations: Mount Pleasant, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1087626Mt Pleasant Dermatology, LLC570 Long Point Road, Suite 200, Mt Pleasant, SC 29464ComplianceJul 26, 2027

National Provider Directory

National Provider Directory

Locations

570 Long Point Rd
Ste 200
Mt Pleasant, SC 29464
Phone (843) 881-0320

Practitioners & affiliated clinicians

Practitioners 10

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": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1821048828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 LONG POINT ROAD",
            "address_2": "SUITE 200",
            "city": "MT. PLEASANT",
            "state": "SC",
            "postal_code": "29464",
            "telephone_number": "843-881-0320",
            "fax_number": "843-881-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 LONG POINT ROAD",
            "address_2": "SUITE 200",
            "city": "MT. PLEASANT",
            "state": "SC",
            "postal_code": "29464",
            "telephone_number": "843-881-0320",
            "fax_number": "843-881-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT PLEASANT DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "ROPER",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "843-936-7189",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0213",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt. Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.