NPIMap

Individual provider Active NPI

Kurt Alexander Waldthausen

  • Medical Physician Assistant
  • West Columbia, SC
National Provider Identifier
1952983173
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
146 E Hospital Dr Ste 200
West Columbia, SC 29169-4800
Phone
(803) 791-2000
NPI assigned
Apr 27, 2021
Last updated
Apr 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

146 E Hospital Dr Ste 200
West Columbia, SC 29169-4800

Mailing address

241 Rolling Rock Rd
Columbia, SC 29212-3022
Phone (864) 477-8142

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.entlexington.com/ Lexington Medical Center

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
I20210719001482 SC Practitioner - Physician Assistant 6507269297 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Carolina School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston ENT Associates, LLCGroup PAC ID 4082662234, 77 clinicians

Practice addresses (Care Compare)

1849 Savage Rd
Charleston, SC 29407-4726
Phone (843) 766-7103

2295 Henry Tecklenburg Dr
Charleston, SC 29414-7801
Phone (843) 766-7103

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.33 of 100Reported as group
Quality
86.06
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3984SCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston ENT Associates, LLC CurrentSince Jul 12, 2022 Accepting new patients
Lexington Health Inc CurrentSince Jul 15, 2021 Accepting new patients
Lexington Health Inc CurrentSince Jul 15, 2021 Accepting new patients

Locations

1849 Savage Rd
Charleston, SC 29407
Phone (843) 576-2600

2295 Henry Tecklenburg Dr
Charleston, SC 29414

811 W Main St
Ste 101
Lexington, SC 29072
Phone (803) 936-7230

146 E Hospital Dr
Ste 200
West Columbia, SC 29169
Phone (803) 739-3550

Interoperability endpoints

  • Direct secure messaging: kurt.waldthausen.p1@direct.entap.nextgenshare.com

Organizations & group practices 5

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 2

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": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1952983173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 ROLLING ROCK RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292123022",
            "telephone_number": "864-477-8142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 E HOSPITAL DR STE 200",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694800",
            "telephone_number": "803-791-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDTHAUSEN",
        "first_name": "KURT",
        "middle_name": "ALEXANDER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-27",
        "last_updated": "2021-04-27",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.entlexington.com/",
            "affiliation": "Y",
            "affiliationName": "Lexington Medical Center",
            "address_1": "146 E Hospital Dr Ste 200",
            "city": "West Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291694800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Columbia, SC

Sources for this page

Verify at the official NPI Registry.