NPIMap

Organization Active NPI

Pattisons D R E a M Academy

  • Rehabilitation Clinic/Center
  • Charleston, SC
National Provider Identifier
1861678534
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PATTISONS D R E A M ACADEMY
Practice address
721 Wappoo Rd
Charleston, SC 29407-5861
Phone
(843) 402-7850
Fax
(843) 402-7850
NPI assigned
Jan 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Authorized official

Name
Dr. Laura Ganci
Title
Executive Director
Phone
(843) 402-7850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

721 Wappoo Rd
Charleston, SC 29407-5861

Mailing address

PO Box 80426
Charleston, SC 29416-0426
Phone (843) 402-7850

Other identifiers 1

IdentifierTypeStateIssuer
GP4825-1861678535MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200813001033 SC Part B Supplier - Clinic/Group Practice 4385060995 Receives reassigned benefits from 5 practitioners
Practice locations: Charleston, SC

National Provider Directory

National Provider Directory

Locations

721 Wappoo Rd
Charleston, SC 29407
Phone (843) 203-3891

2383 Highway 41
Ste 101
Mt Pleasant, SC 29466
Phone (843) 849-6707

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1200096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698278400000",
    "number": "1861678534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80426",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294160426",
            "telephone_number": "843-402-7850",
            "fax_number": "843-402-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 WAPPOO RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075861",
            "telephone_number": "843-402-7850",
            "fax_number": "843-402-7850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATTISONS D R E A M ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-12",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "GANCI",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "843-402-7850",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4825-1861678535",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.