Carolina Podiatry Clinic LLC

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

563 Issued in SC

Legal business name

CAROLINA PODIATRY CLINIC LLC

Practice address

2502 Broad St
Camden, SC 29020

Phone

(803) 425-5510

Fax

(803) 432-4776

NPI assigned

Feb 25, 2010

Last updated

Aug 17, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Ksor, DPMNPI 1346384971

Title

Podiatrist

Phone

(864) 494-0534

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 3

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.

• John Ksor, DPM

  • Primary Podiatric Medicine Podiatrist
  • Camden, SC
  • NPI 1346384971
  Medicare reassignment Care Compare group NPD Authorized official
• Jonathan Braun Ksor, D.P.M.

  • Podiatrist
  • Camden, SC
  • NPI 1326254848
  Medicare reassignment Care Compare group NPD
• Richard A Burnell, DPM

  • Podiatrist
  • Camden, SC
  • NPI 1679678122
  NPD (past)

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

{
    "created_epoch": "1267056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1932421385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 BROAD ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290202240",
            "telephone_number": "803-425-5510",
            "fax_number": "803-432-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 BROAD ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "29020",
            "telephone_number": "803-425-5510",
            "fax_number": "803-432-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA PODIATRY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-25",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "KSOR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "864-494-0534",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": "DE3794",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": "6460510001",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "SC",
            "license": "563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DQ3852",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP9894",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marguerite Mealor Carlton, MD
• Carolina Cardiovascular Consultants LLC (Carolina Cardiovascular Consultants)
• Carolina Cataract Clinic
• Carolina Consortium of Care, LLC
• Carolina Orthotics and Prosthetics LLC
• Crystal Jean Carraway, LCSW
• Raven Simone Carraway
• Kenneth W. Carson, DDS, PA
• Christopher Thomas Catalano, BA
• Center of Change

• Primary Podiatric Medicine Podiatrist in Camden, SC
• Providers in Camden, SC by specialty
• Primary Podiatric Medicine Podiatrist in South Carolina

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

Verify at the official NPI Registry.