NPIMap

Organization Active NPI

Palmetto Medical Group, PLLC

  • Internal Medicine Physician
  • Waxhaw, NC
National Provider Identifier
1922522150
Registry record updated Jul 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PALMETTO MEDICAL GROUP, PLLC
Practice address
1505 Funny Cide Dr
Waxhaw, NC 28173-7258
Phone
(803) 548-7007
NPI assigned
Jul 31, 2017
Organization subpart
Yes
Parent organization
PALMETTO MEDICAL GROUP, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2017

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

Authorized official

Name
Amit G ShahNPI 1740288323
Title
MD
Phone
(803) 548-7007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1505 Funny Cide Dr
Waxhaw, NC 28173-7258

Mailing address

1040 Edgewater Corporate Pkwy Ste 101
Indian Land, SC 29707-4514
Phone (803) 548-7007

Other identifiers 1

IdentifierTypeStateIssuer
0OtherN/A

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241231002262 NC Part B Supplier - Clinic/Group Practice 5496823817 Receives reassigned benefits from 1 practitioner
Practice locations: Waxhaw, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Palmetto Medical Group PLLC

Locations

1040 Edgewater Corporate Pkwy
Ste 101
Indian Land, SC 29707
Phone (803) 548-7007

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501459200000",
    "number": "1922522150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 EDGEWATER CORPORATE PKWY STE 101",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297074514",
            "telephone_number": "803-548-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 FUNNY CIDE DR",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281737258",
            "telephone_number": "803-548-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO MEDICAL GROUP, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALMETTO MEDICAL GROUP, PLLC",
        "enumeration_date": "2017-07-31",
        "last_updated": "2017-07-31",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "AMIT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "803-548-7007"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waxhaw, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; 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.