Sudipta Misra, MD

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

51197 Issued in SC

Practice address

295A Midland Pkwy Ste 260
Summerville, SC 29485-9039

Phone

(843) 695-2700

NPI assigned

Mar 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in SC

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sudipta.misra@hca5.eclinicaldirectplus.com

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.

• Coastal Carolina Multispecialty Associates, LLC

  • Specialist
  • Summerville, SC
  • NPI 1518079102
  Medicare reassignment NPD
• Coastal Carolina Multispecialty Assocs, LLC

  • Specialist
  • North Charleston, SC
  • NPI 1184730749
  NPD (past)
• Coastal Inpatient Physicians, LLC

  • Internal Medicine Physician
  • Charleston, SC
  • NPI 1215043872
  NPD (past)
• Augusta University

  • Hospitalist Physician
  • Augusta, GA
  • NPI 1760559124
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1932177052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295-A MIDLAND PARKWAY",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "29485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295A MIDLAND PKWY STE 260",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294859039",
            "telephone_number": "843-695-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2160 Herbert Court",
            "address_2": "ECU Physicians Pediatric Gastroenterology",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278343736",
            "country_code": "US",
            "telephone_number": "252-744-5437",
            "fax_number": "252-744-1514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISRA",
        "first_name": "SUDIPTA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NC",
            "license": "2012-00929",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "IL",
            "license": "036097590",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "SC",
            "license": "51197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "IL01Y9",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036097890",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G59563",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07215036",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921082",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "171H6",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Crystal Milroy
• Mindset Counseling and Coaching, LLC
• Mindshift Counseling Group, LLC
• Jennifer Minus, CRT, RRT, RCP
• Dalia Janette Miranda
• Michael Richard Missroon, PHARMACIST
• Amy Mitchell-Washington, LPC, LPCS
• Cassandra Liston Mitchell, DDS
• Jacquetta E Mitchell
• Racheal C Mitchell, PHARMD

• Pediatric Gastroenterology Physician in Summerville, SC
• Providers in Summerville, SC by specialty
• Pediatric Gastroenterology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.