NPIMap

Individual provider Active NPI

Jillian Prestigiacomo, PA-C

  • Physician Assistant
  • Johns Island, SC
National Provider Identifier
1922723642
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4599 Issued in SC
Practice address
3089 Vincent Astor Dr
Johns Island, SC 29455-8279
Phone
(803) 521-1744
NPI assigned
Oct 5, 2022
Last updated
Feb 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4599 SC Primary

Addresses

Primary practice location

3089 Vincent Astor Dr
Johns Island, SC 29455-8279

Mailing address

3089 Vincent Astor Dr
Johns Island, SC 29455-8279
Phone (803) 521-1744

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
I20230317002399 SC Practitioner - Physician Assistant 7517331333 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cora South Carolina LLCGroup PAC ID 3173766334, shared by 6 NPIs, 220 clinicians

Practice addresses (Care Compare)

1106 Chuck Dawley Blvd
Mount Pleasant, SC 29464-4183
Phone (843) 792-1414

1122 Chuck Dawley Blvd
Mt Pleasant, SC 29464-4183
Phone (843) 792-6200

167 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

2060 Sam Rittenberg Blvd
Charleston, SC 29407-4616
Phone (843) 792-1414

2724 W Palmetto St
Suite 2
Florence, SC 29501-4909
Phone (843) 292-1900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.02 of 100Reported as group
Quality
62.41
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4599SCMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol Physician Assistant CurrentSince Feb 9, 2023 Accepting new patients

Locations

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

Interoperability endpoints

  • Direct secure messaging: jpolk368838@direct.musc.edu

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1664928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1922723642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3089 VINCENT ASTOR DR",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294558279",
            "telephone_number": "803-521-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3089 VINCENT ASTOR DR",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294558279",
            "telephone_number": "803-521-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESTIGIACOMO",
        "first_name": "JILLIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-05",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Island, SC

Sources for this page

Verify at the official NPI Registry.