NPIMap

Individual provider Active NPI

Kaitlyn Edgington, PA-C

  • Physician Assistant
  • Irmo, SC
National Provider Identifier
1932675709
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
7611 Saint Andrews Rd
Irmo, SC 29063-2834
Phone
(803) 714-3300
Fax
(803) 626-9356
NPI assigned
Oct 19, 2018
Last updated
Apr 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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 NU Primary

Addresses

Primary practice location

7611 Saint Andrews Rd
Irmo, SC 29063-2834

Mailing address

PO Box 530062
Atlanta, GA 30353-0062
Phone (843) 572-7727

Other identifiers 1

IdentifierTypeStateIssuer
3353PAMedicaidSC

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
I20191209001456 SC Practitioner - Physician Assistant 8527491372 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1401 Main St
Bonneau, SC 29431-5013
Phone (843) 695-6071

2500 Elms Ctr Rd
N Charleston, SC 29406-9844
Phone (843) 695-6071

2550 Elms Ctr Rd
North Charleston, SC 29406-9844
Phone (843) 695-6071

7611 Saint Andrews Rd
Irmo, SC 29063-2834
Phone (843) 695-6071

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3320SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Colonial Family Practice, LLC Physician Assistant CurrentSince Oct 15, 2020 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Feb 5, 2024 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Feb 5, 2024 Accepting new patients
Colonial Family Practice, LLC CurrentSince Oct 15, 2020 Accepting new patients
Palmetto Primary Care Physicians, LLC Past Accepting new patients
Palmetto Primary Care Physicians, LLC Past Accepting new patients

Locations

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

1124 Little St
Camden, SC 29020
Phone (803) 432-9899

7611 Saint Andrews Rd
Irmo, SC 29063
Phone (803) 714-3300

2500 Elms Center Rd
North Charleston, SC 29406
Phone (763) 348-2075

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

325 Broad St
Ste 100
Sumter, SC 29150

674 W Liberty St
Sumter, SC 29150
Phone 80377352276010

Interoperability endpoints

  • Direct secure messaging: kaitlyn.edgington@ppcp1.eclinicaldirectplus.com

Organizations & group practices 8

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": "1539907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1932675709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530062",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303530062",
            "telephone_number": "843-572-7727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7611 SAINT ANDREWS RD",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632834",
            "telephone_number": "803-714-3300",
            "fax_number": "803-626-9356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGINGTON",
        "first_name": "KAITLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-19",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3353PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irmo, SC

Sources for this page

Verify at the official NPI Registry.