NPIMap

Organization Active NPI

Palmetto Digestive Disease PA

  • Specialist
  • Charleston, SC
National Provider Identifier
1922057843
Registry record updated May 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PALMETTO DIGESTIVE DISEASE PA
Practice address
2073 Charlie Hall Blvd
Charleston, SC 29414-5834
Phone
(843) 571-0643
Fax
(843) 377-0499
NPI assigned
May 8, 2006
Last updated
May 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2020

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

Authorized official

Name
Ms. Sonya Wyatt
Title
Ceo
Phone
(843) 571-0643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

2073 Charlie Hall Blvd
Charleston, SC 29414-5834

Mailing address

2073 Charlie Hall Blvd
Charleston, SC 29414-5834
Phone (843) 571-0643

Other practice location 1

300 Callen Blvd Ste 220
Summerville, SC 29486-2809
Phone (843) 571-0643

Other practice location 2

2061 Highway 52
Moncks Corner, SC 29461-5017
Phone (843) 571-0643

Other practice location 3

3510 Highway 17 Byp N Ste 325
Mount Pleasant, SC 29466-8232
Phone (843) 571-0643

Other identifiers 1

IdentifierTypeStateIssuer
GP0775MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ppd@directaddress.net

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040521000237 SC Part B Supplier - Clinic/Group Practice 7719978444 Receives reassigned benefits from 27 practitioners
Practice locations: Charleston, SC; Goose Creek, SC; Moncks Corner, SC; Mt 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
42D0942418Palmetto Digestive Disease, PA2073 Charlie Hall Blvd, Charleston, SC 29414ComplianceApr 29, 2028

National Provider Directory

National Provider Directory

Locations

125 Doughty St
Ste 380
Charleston, SC 29403
Phone (803) 577-9530

3516 S Live Oak Dr
Unit B
Moncks Corner, SC 29461
Phone (843) 797-8162

Interoperability endpoints

  • Direct secure messaging: ppd@directaddress.net

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589414400000",
    "number": "1922057843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2073 CHARLIE HALL BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145834",
            "telephone_number": "843-571-0643",
            "fax_number": "843-377-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2073 CHARLIE HALL BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145834",
            "telephone_number": "843-571-0643",
            "fax_number": "843-377-0499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Callen Blvd Ste 220",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294862809",
            "country_code": "US",
            "telephone_number": "843-571-0643",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2061 Highway 52",
            "address_purpose": "LOCATION",
            "city": "Moncks Corner",
            "state": "SC",
            "postal_code": "294615017",
            "country_code": "US",
            "telephone_number": "843-571-0643",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3510 Highway 17 Byp N Ste 325",
            "address_purpose": "LOCATION",
            "city": "Mount Pleasant",
            "state": "SC",
            "postal_code": "294668232",
            "country_code": "US",
            "telephone_number": "843-571-0643",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALMETTO DIGESTIVE DISEASE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "SONYA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-571-0643",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0775",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ppd@directaddress.net",
            "affiliation": "N",
            "address_1": "2073 Charlie Hall Blvd",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294145834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 May 14, 2020; 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.