NPIMap

Individual provider Active NPI

Nathan John Averill, MD

  • Family Medicine Physician
  • Moncks Corner, SC
National Provider Identifier
1891824355
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
28895 Issued in SC
Practice address
2061 Highway 52
Moncks Corner, SC 29461-5017
Phone
(843) 761-8800
Fax
(843) 761-8824
NPI assigned
Mar 2, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 28895 SC Primary

Addresses

Primary practice location

2061 Highway 52
Moncks Corner, SC 29461-5017

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
288799MedicaidSC

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
I20090925000596 SC Practitioner - Family Practice 1850447210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kentucky College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palmetto Primary Care Physicians LLCGroup PAC ID 4880508068, 148 clinicians

Practice addresses (Care Compare)

3495 Iron Horse Rd
Ladson, SC 29456-4319
Phone (843) 695-6071

Hospital & facility affiliations

  • Amedisys Home Health of Charleston Home health agency, North Charleston, SC, CCN 427005
  • Interim Healthcare Home health agency, North Charleston, SC, CCN 427132
  • Trident Medical Center Hospital, Charleston, SC, CCN 420079
  • Roper Hospital Hospital, Charleston, SC, CCN 420087
  • Roper St Francis Hospital-Berkeley Inc Hospital, Summerville, SC, CCN 420110
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28895SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Palmetto Primary Care Physicians, LLC Family Medicine Current Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine CurrentSince Jun 11, 2018 Accepting new patients
Palmetto Primary Care Physicians, LLC Family Medicine CurrentSince Jun 11, 2018 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

3495 Iron Horse Rd
Ladson, SC 29456
Phone (843) 793-5970

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

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

Interoperability endpoints

  • Direct secure messaging: nathan.averill@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 11

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": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1891824355",
    "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": "2061 HIGHWAY 52",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294615017",
            "telephone_number": "843-761-8800",
            "fax_number": "843-761-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVERILL",
        "first_name": "NATHAN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "28895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288799",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

Verify at the official NPI Registry.