Samuel Jay Peretsman, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

9500688 Issued in NC

Practice address

201 Queens Rd
Charlotte, NC 28204-3217

Phone

(704) 372-5180

Fax

(704) 376-6280

NPI assigned

Jun 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC, SC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Urology

Education

Boston University School of Medicine, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McLeod Regional Medical Center of the Pee Dee IncGroup PAC ID 7416851852, 401 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLeod Regional Medical Center-Pee Dee Hospital, Florence, SC, CCN 420051

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: speretsman97215@directmcleodehealth.org

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.

• McLeod Regional Medical Center of the Pee Dee, Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Florence, SC
  • NPI 1154371433
  Medicare reassignment Care Compare group NPD
• Carolinas Medical Center

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1275774333
  Medicare reassignment NPD
• Stone Institute of the Carolinas LLC

  • Urology Physician
  • Davidson, NC
  • NPI 1457377954
  Medicare reassignment NPD
• Prisma Health Medical Group-Midlands

  • Multi-Specialty Clinic/Center
  • Columbia, SC
  • NPI 1275988321

  Urology

  Medicare reassignment NPD
• Carolinas Medical Center

  • Child & Adolescent Psychiatry Physician
  • Charlotte, NC
  • NPI 1548501141
  NPD
• Carolinas Medical Center

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1982710554
  NPD
• Urology Specialists of the Carolinas

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1992544654
  NPD
• Deaconess Clinic Inc

  • Pediatrics Physician
  • Washington, IN
  • NPI 1356132310
  NPD
• Deaconess Clinic Inc.

  • Internal Medicine Physician
  • Evansville, IN
  • NPI 1619123585

  Urology

  NPD
• Deaconess Clinic, Inc

  • Pediatrics Physician
  • Newburgh, IN
  • NPI 1376799213

  Urology

  NPD
• McLeod Regional Medical Center of the Pee Dee, Inc

  • Community/Retail Pharmacy
  • Florence, SC
  • NPI 1871775841
  NPD
• Prisma Health Medical Group-Midlands

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Columbia, SC
  • NPI 1295222503
  NPD

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

• McLeod Regional Medical Center of the Pee Dee, Inc.

  • General Acute Care Hospital
  • Florence, SC
  • NPI 1699756221
  Care Compare affiliation

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1912946336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36488",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282366488",
            "telephone_number": "704-248-3400",
            "fax_number": "704-337-8387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 QUEENS RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043217",
            "telephone_number": "704-372-5180",
            "fax_number": "704-376-6280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Taylor St Ste 1A",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292012946",
            "country_code": "US",
            "telephone_number": "803-434-4790",
            "fax_number": "803-434-4799",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERETSMAN",
        "first_name": "SAMUEL",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SC",
            "license": "89031",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "9500688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS PROVIDER #",
            "identifier": "10465",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDI PROVIDER #",
            "identifier": "66833",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE INDI #",
            "identifier": "340016821",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sirena Peralta, BCBA, MS
• Shantrease Perdomo, LMBT
• Maurice Perdue
• Tammy J Pereboom, PT
• Cristina Maria Pereira
• Adenia Perez Lopez, LCSW
• Ana Beatriz Perez Saez
• Mariely Perez Soto, DC
• Matti Perez-Cubas, M.A. CCC-SLP
• Christian O. Perez-Santiago, LMBT

• Urology Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Urology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.