NPIMap

Organization Active NPI

Trident Anesthesia Group, LLC

Doing business as Pain Care Physicians of Charleston, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Charleston, SC
National Provider Identifier
1952597551
Registry record updated Jul 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
TRIDENT ANESTHESIA GROUP, LLC
Doing business as
Pain Care Physicians of Charleston, LLC
Practice address
9263 Medical Plaza Dr
Ste B
Charleston, SC 29406-7112
Phone
(843) 414-1224
Fax
(843) 414-1226
NPI assigned
Sep 18, 2007
Last updated
Jul 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2012

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

Authorized official

Name
Dr. Richard L Fishman, M.D.NPI 1518935352
Title
Partner/Medical Director
Phone
(843) 414-1224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X Primary

Addresses

Primary practice location

9263 Medical Plaza Dr
Ste B
Charleston, SC 29406-7112

Mailing address

9263 Medical Plaza Dr
Suite E
Charleston, SC 29406-7112
Phone (843) 414-1224

Other identifiers 2

IdentifierTypeStateIssuer
GP0090MedicaidSC
GP4750MedicaidSC

Other names 1

  • Pain Care Physicians of Charleston, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pain Care Physicians of Charleston LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9326 Medical Plaza Dr
Ste C
Charleston, SC 29406
Phone (843) 414-1224

9263 Medical Plaza Dr
Ste B
North Charleston, SC 29406
Phone (843) 414-1224

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342656000000",
    "number": "1952597551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9263 MEDICAL PLAZA DR",
            "address_2": "SUITE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294067112",
            "telephone_number": "843-414-1224",
            "fax_number": "843-414-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9263 MEDICAL PLAZA DR",
            "address_2": "STE B",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294067112",
            "telephone_number": "843-414-1224",
            "fax_number": "843-414-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT ANESTHESIA GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2012-07-19",
        "status": "A",
        "authorized_official_last_name": "FISHMAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "843-414-1224",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0090",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4750",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pain Care Physicians of Charleston, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.