NPIMap

Individual provider Active NPI

Charles A Bickerstaff Jr., MD

  • Gastroenterology Physician
  • Charleston, SC
National Provider Identifier
1972584712
Registry record updated Aug 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
8659 Issued in SC
Practice address
102 Wappoo Creek Dr Ste 10C
Charleston, SC 29412
Phone
(843) 762-9321
Fax
(843) 406-9777
NPI assigned
Nov 9, 2005
Last updated
Aug 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 8659 SC Primary

Addresses

Primary practice location

102 Wappoo Creek Dr Ste 10C
Charleston, SC 29412

Mailing address

452 Folly Rd
Suite a
Charleston, SC 29412-2641
Phone (843) 762-9321

Other identifiers 1

IdentifierTypeStateIssuer
GP3774MedicaidSC

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
I20111202000416 SC Practitioner - Gastroenterology 7911894399 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Medical College of Georgia School of Medicine, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

500 Thurgood Marshall Hwy
Suite F
Kingstree, SC 29556-4143
Phone (843) 355-1772

511 S Main St
Mullins, SC 29574-3509
Phone (843) 464-8244

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.15 of 100Reported as group
Quality
83.18
Promoting interoperability
98
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy14
Upper gastrointestinal (GI) endoscopy for acid reflux17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
8659SCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Gastroenterology & Nutrition Clinics, LLC CurrentSince Jul 1, 2003 Accepting new patients
Medical University Hospital Authority Current Accepting new patients
Medical University Hospital Authority CurrentSince Dec 5, 2022 Accepting new patients
Medical University Hospital Authority CurrentSince Dec 5, 2022 Accepting new patients
Asthma, Allergy and Immunology Clinics, LLC Past Accepting new patients

Locations

102 Wappoo Creek Dr
Ste 10C
Charleston, SC 29412
Phone (843) 762-9321

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

452 Folly Rd
Ste A
Charleston, SC 29412
Phone (843) 762-9321

500 Thurgood Marshall Hwy
Ste F
Kingstree, SC 29556
Phone (843) 355-7461

511 S Main St
Mullins, SC 29574
Phone (843) 464-8244

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

Interoperability endpoints

  • Direct secure messaging: cbickerstaff411987@direct.musc.edu

Organizations & group practices 6

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": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535328000000",
    "number": "1972584712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "452 FOLLY RD",
            "address_2": "SUITE A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294122641",
            "telephone_number": "843-762-9321",
            "fax_number": "843-406-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 WAPPOO CREEK DR STE 10C",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29412",
            "telephone_number": "843-762-9321",
            "fax_number": "843-406-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BICKERSTAFF",
        "first_name": "CHARLES",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2018-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SC",
            "license": "8659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3774",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.