Courtney B Moldenhauer, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

TL1621 Issued in SC

Practice address

9267 Medical Plaza Dr Ste G
N Charleston, SC 29406-9139

Phone

(843) 797-3636

Fax

(843) 797-3637

NPI assigned

Feb 1, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Courtney E Bock 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

Medical University of South Carolina College of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Trident Pain Center LLCGroup PAC ID 7911897269, 18 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trident Pain Center LLC

  • Interventional Pain Medicine Physician
  • N Charleston, SC
  • NPI 1801992961
  Medicare reassignment Care Compare group NPD
• Trident Pain Center LLC

  • Pain Medicine Physician
  • West Columbia, SC
  • NPI 1659915445
  NPD

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

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1992001465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9267 MEDICAL PLAZA DR STE G",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294069139",
            "telephone_number": "843-797-3636",
            "fax_number": "843-797-3637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9267 MEDICAL PLAZA DR STE G",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294069139",
            "telephone_number": "843-797-3636",
            "fax_number": "843-797-3637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Highland Center Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292039127",
            "country_code": "US",
            "telephone_number": "843-797-3636",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "176 McSwain Dr",
            "address_purpose": "LOCATION",
            "city": "West Columbia",
            "state": "SC",
            "postal_code": "291694825",
            "country_code": "US",
            "telephone_number": "843-797-3636",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1930 Charlie Hall Blvd",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294145837",
            "country_code": "US",
            "telephone_number": "843-797-3636",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 Eddie Chasteen Dr",
            "address_purpose": "LOCATION",
            "city": "Walterboro",
            "state": "SC",
            "postal_code": "294885728",
            "country_code": "US",
            "telephone_number": "843-797-3636",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "108 N Highway 52",
            "address_purpose": "LOCATION",
            "city": "Moncks Corner",
            "state": "SC",
            "postal_code": "294613910",
            "country_code": "US",
            "telephone_number": "843-797-3636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOLDENHAUER",
        "first_name": "COURTNEY",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-01",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1621",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "TL1621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "BOCK",
            "middle_name": "E",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephen P Merrell, DMD
• Michael D. Schall, OD, PA
• Melanie Wells Miller, PA-C
• Dana Millet, RN, BSN, MHA
• Dawn C Mills, ANP
• National Vision, Inc.
• Casey Burall Nemtuda, DPT
• Sharon D Noisette
• Joseph Edward Nolan, MD
• Northwoods Internal Medicine

• Physician Assistant in N Charleston, SC
• Providers in N Charleston, 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 3, 2021; 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.