Mary Kathryn Dickson Staub, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4657 Issued in SC

Practice address

104 Ellett Rd
Chapin, SC 29036-8604

Phone

(803) 941-8095

NPI assigned

Oct 21, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary Kathryn Dickson Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Palmetto Bone and JointGroup PAC ID 4385545565, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Newberry County Memorial Hospital Hospital, Newberry, SC, CCN 420053

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Palmetto Bone and Joint

  • Orthopaedic Surgery Physician
  • Newberry, SC
  • NPI 1720295793
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Newberry County Memorial Hospital

  • General Acute Care Hospital
  • Newberry, SC
  • NPI 1316030083
  Care Compare affiliation

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

{
    "created_epoch": "1666310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1952028896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 LIGHTHOUSE RD",
            "city": "CHAPIN",
            "state": "SC",
            "postal_code": "290368590",
            "telephone_number": "803-606-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 ELLETT RD",
            "city": "CHAPIN",
            "state": "SC",
            "postal_code": "290368604",
            "telephone_number": "803-941-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUB",
        "first_name": "MARY",
        "middle_name": "KATHRYN DICKSON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-21",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTH CAROLINA PHYSICIAN ASSISTANT LICENSE NUMBER",
            "identifier": "4657",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "DICKSON",
            "middle_name": "KATHRYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Casie Smith, NP-C
• Specialized Mobility, LLC
• Candace Sprouse, LISW-CP, OSW-C
• Suzanne Brooke Starkey, PT OCS
• Lauren Kendall Starks, PTA
• Stephen Andrew Stellfox, D.C.
• Karli Richards Stenger, DPM
• Michelle Stephens, OTR/L
• Patricia Stevenson, PH.D.
• Kelly Workman Strickland

• Physician Assistant in Chapin, SC
• Providers in Chapin, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.