NPIMap

Organization Active NPI

Premier Medical of SC LLC

  • Family Medicine Physician
  • North Charleston, SC
National Provider Identifier
1992276091
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREMIER MEDICAL OF SC LLC
Practice address
5880 Rivers Ave
North Charleston, SC 29406-6053
Phone
(843) 225-2374
Fax
(843) 459-1923
NPI assigned
Dec 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Authorized official

Name
Karey Breen, MDNPI 1154582047
Title
MD
Phone
(843) 225-2374

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5880 Rivers Ave
North Charleston, SC 29406-6053

Mailing address

354 Folly Rd Ste 5
Charleston, SC 29412-2594
Phone (843) 225-2374

Other practice location 1

354 Folly Rd Ste 5
Charleston, SC 29412-2594
Phone (843) 225-2374

Other identifiers 2

IdentifierTypeStateIssuer
GP9928MedicaidSC
PG0752MedicaidSC

Other names 1

  • Premier Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190322000975 SC Part B Supplier - Clinic/Group Practice 0042550386 Receives reassigned benefits from 14 practitioners
Practice locations: Charleston, SC; North Charleston, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2164828Premier Medical of SC354 Folly Rd, Charleston, SC 29412Certificate of waiverApr 14, 2027
42D2228315Premier Medical of SC5880 Rivers Ave, North Charleston, SC 29406Certificate of waiverJun 23, 2027

National Provider Directory

National Provider Directory

Locations

354 Folly Rd
Charleston, SC 29412
Phone (843) 501-9500

354 Folly Rd
Ste 5
Charleston, SC 29412
Phone (843) 225-2374

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1992276091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 FOLLY RD STE 5",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294122594",
            "telephone_number": "843-225-2374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5880 RIVERS AVE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294066053",
            "telephone_number": "843-225-2374",
            "fax_number": "843-459-1923"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "354 Folly Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294122594",
            "country_code": "US",
            "telephone_number": "843-225-2374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER MEDICAL OF SC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A",
        "authorized_official_last_name": "BREEN",
        "authorized_official_first_name": "KAREY",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "843-225-2374",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP9928",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PG0752",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premier Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.