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2100 Charlie Hall Blvd Charleston SC 29414-5832 | |
| (843) 852-4100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2100 Charlie Hall Blvd, Charleston, South Carolina |
| Authorized Official Name and Position | Tracy L Turner (CONTROLLER) |
| Authorized Official Contact | 8038988503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2100 Charlie Hall Blvd Charleston SC 29414-5832 Ph: (843) 852-4100 | 2100 Charlie Hall Blvd Charleston SC 29414-5832 Ph: (843) 852-4100 |
| NPI Number | 1760596480 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 06/20/2024 |
| Medicare PECOS PAC ID | 9032021175 |
|---|---|
| Medicare Enrollment ID | O20031215000552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760596480 | NPI | - | NPPES |
| 190166 | Medicaid | SC | |
| 20048847 | Other | SC | SELECT HEALTH MEDICAID HM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Donna Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053348672 PECOS PAC ID: 7618965070 Enrollment ID: I20040504000921 |
| Provider Name | Lady M Carr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629029913 PECOS PAC ID: 1254320203 Enrollment ID: I20040506001165 |
| Provider Name | Rebecca Tummons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053371716 PECOS PAC ID: 9234187519 Enrollment ID: I20050104000757 |
| Provider Name | Gary B Ewing |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1861451650 PECOS PAC ID: 6507882776 Enrollment ID: I20051017000959 |
| Provider Name | Shilpa Srinivasan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639105232 PECOS PAC ID: 2961434691 Enrollment ID: I20060803000208 |
| Provider Name | Scott D Christie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578655205 PECOS PAC ID: 3476550245 Enrollment ID: I20061109000105 |
| Provider Name | Melanie Taylor Hatzis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154424398 PECOS PAC ID: 0345343695 Enrollment ID: I20070307000427 |
| Provider Name | Michell R Herring |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861585754 PECOS PAC ID: 6608970215 Enrollment ID: I20070409000143 |
| Provider Name | Rhonda S Kalil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740490317 PECOS PAC ID: 8224121702 Enrollment ID: I20070830000035 |
| Provider Name | Sherie R Corbett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255477550 PECOS PAC ID: 2062508716 Enrollment ID: I20071011000358 |
| Provider Name | Robin C Nance |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811080815 PECOS PAC ID: 3375625908 Enrollment ID: I20080204000644 |
| Provider Name | Allison K Hamada |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831304880 PECOS PAC ID: 3678652872 Enrollment ID: I20080429000704 |
| Provider Name | Kim J Gilmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184810665 PECOS PAC ID: 8022187368 Enrollment ID: I20080513000453 |
| Provider Name | Kimberly B Rudd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578694147 PECOS PAC ID: 9830247139 Enrollment ID: I20090424000253 |
| Provider Name | Kim B Edford-davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629269311 PECOS PAC ID: 7315131455 Enrollment ID: I20101102000944 |
| Provider Name | David Beckert |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154403475 PECOS PAC ID: 8921293341 Enrollment ID: I20101111000475 |
| Provider Name | Maria M Modesto |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134235336 PECOS PAC ID: 0749380061 Enrollment ID: I20110113000841 |
| Provider Name | Fred C Osher |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154330538 PECOS PAC ID: 6406035260 Enrollment ID: I20110125001146 |
| Provider Name | James E Edwards |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174631113 PECOS PAC ID: 3173704095 Enrollment ID: I20110225000526 |
| Provider Name | Pascale N Mardikian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649460577 PECOS PAC ID: 9234311408 Enrollment ID: I20110309000258 |
| Provider Name | Trenten Aristotle Prioleau |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1104129790 PECOS PAC ID: 4981887783 Enrollment ID: I20110331000170 |
| Provider Name | Emily M Rountree |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477635605 PECOS PAC ID: 2668640525 Enrollment ID: I20110720000002 |
| Provider Name | Michael Kassur |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508876491 PECOS PAC ID: 8729012646 Enrollment ID: I20110831000051 |
| Provider Name | Ann L Taylor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760596522 PECOS PAC ID: 9436316585 Enrollment ID: I20120201000896 |
| Provider Name | Shilpy Kadian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760619654 PECOS PAC ID: 9436303732 Enrollment ID: I20130214000535 |
| Provider Name | Joseph M Crawford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003155755 PECOS PAC ID: 3072749795 Enrollment ID: I20131202000085 |
| Provider Name | Taylor N Crews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124300058 PECOS PAC ID: 1759603996 Enrollment ID: I20141125001680 |
| Provider Name | Jennifer Janell Patterson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700047198 PECOS PAC ID: 3375866841 Enrollment ID: I20150108002049 |
| Provider Name | Thomas W Walsh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528114683 PECOS PAC ID: 1850306408 Enrollment ID: I20150129002461 |
| Provider Name | Christy M Blair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407194129 PECOS PAC ID: 9638482193 Enrollment ID: I20150714000231 |
| Provider Name | Sarah S Kuhn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972814911 PECOS PAC ID: 4981910833 Enrollment ID: I20150909000004 |
| Provider Name | Adrienne L Pruitt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093035321 PECOS PAC ID: 8921315730 Enrollment ID: I20150910002420 |
| Provider Name | Ryan R Byrne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063619773 PECOS PAC ID: 5294990602 Enrollment ID: I20151109002415 |
| Provider Name | Rushiraj Chaitanya Laiwala |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497985303 PECOS PAC ID: 6002063757 Enrollment ID: I20160721002303 |
| Provider Name | Staci R Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518284553 PECOS PAC ID: 0446520308 Enrollment ID: I20170725004159 |
| Provider Name | Laura Kathleen Tait |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124313457 PECOS PAC ID: 4486924180 Enrollment ID: I20170727002205 |
| Provider Name | Emily Jones Cullen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598026601 PECOS PAC ID: 9537458617 Enrollment ID: I20170925002286 |
| Provider Name | Angel L Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114215761 PECOS PAC ID: 8426322686 Enrollment ID: I20170927000568 |
| Provider Name | Cynthia Ruhl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639538242 PECOS PAC ID: 4688937337 Enrollment ID: I20180411002612 |
| Provider Name | Megan C Beauchamp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275034829 PECOS PAC ID: 7315299377 Enrollment ID: I20181003000538 |
| Provider Name | Ilva Genoveva Iriarte |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952663445 PECOS PAC ID: 1557650223 Enrollment ID: I20190205002403 |
| Provider Name | Jared Lee Miller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891177333 PECOS PAC ID: 4789973470 Enrollment ID: I20190910003037 |
| Provider Name | Christopher Robert Pryor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730569245 PECOS PAC ID: 8820387640 Enrollment ID: I20191015001610 |
| Provider Name | David M Friedrich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356720981 PECOS PAC ID: 6901195767 Enrollment ID: I20191127002198 |
| Provider Name | Sarah Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952856809 PECOS PAC ID: 2466740253 Enrollment ID: I20200324002063 |
| Provider Name | Ava J Fiddle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053829655 PECOS PAC ID: 3375958978 Enrollment ID: I20210211002851 |
| Provider Name | Melissa Burlingham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184169930 PECOS PAC ID: 5799187175 Enrollment ID: I20210707002912 |
| Provider Name | Zaixiao Zhang |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1417073453 PECOS PAC ID: 1254733983 Enrollment ID: I20210716001800 |
| Provider Name | Mark Allen Forbes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033689682 PECOS PAC ID: 4385016856 Enrollment ID: I20230209001055 |
Medical University Of Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 67 President St, Charleston, SC 29425 Phone: 843-792-0028 | |
Pluff Mud Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 896 Kushiwah Creek Dr, Charleston, SC 29412 Phone: 843-259-0591 Fax: 843-769-7288 | |
Good Deeds Case Management Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1324 Secessionville Rd, Charleston, SC 29412 Phone: 843-697-4587 | |
Avondale Therapy Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 845 Savannah Hwy, Suite 1c, Charleston, SC 29407 Phone: 843-870-0278 | |
Charleston Mental Wellness, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 25 Cumberland St Ste 120, Charleston, SC 29401 Phone: 843-367-3490 | |
Roper Saint Francis Physicians Network Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2270 Ashley Crossing Dr Ste 135, Charleston, SC 29414 Phone: 843-958-2555 |