Provider Demographics
| NPI: | 1346488251 |
|---|---|
| Name: | COMPASS CAROLINA HEALTH SYSTEMS PA |
| Entity type: | Organization |
| Organization Name: | COMPASS CAROLINA HEALTH SYSTEMS PA |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO/PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | SCOTT |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | SEGAL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 888-852-6672 |
| Mailing Address - Street 1: | 1065 NE 125TH ST STE 300 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | NORTH MIAMI |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33161-5833 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 888-852-6672 |
| Mailing Address - Fax: | 305-891-4228 |
| Practice Address - Street 1: | 1483 TOBIAS GADSON BLVD STE 201 |
| Practice Address - Street 2: | |
| Practice Address - City: | CHARLESTON |
| Practice Address - State: | SC |
| Practice Address - Zip Code: | 29407-4796 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 843-745-5153 |
| Practice Address - Fax: | 843-766-8606 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2009-01-30 |
| Last Update Date: | 2021-07-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
| No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| SC | GP5117 | Medicaid | |
| SC | PTAN9195 | Medicare PIN |
