JOHNATHON ANTONIO MONTREL TUCKER PA
NPI 1912767674
Physician Assistant in Charleston, SC

Q: What is Johnathon Tucker's NPI number?

The NPI number for Johnathon Tucker is 1912767674. It was assigned to this individual provider in the NPPES registry on March 20, 2024.

Q: What is Johnathon Tucker's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Johnathon Tucker was last updated on March 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 20, 2024PECOS Enrolled

4 CARRIAGE LN STE 200, CHARLESTON, SC 29407(843) 266-7573(843) 266-7578 Get Directions Write a Review

NPPES record last updated: March 20, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Johnathon Antonio Montrel Tucker Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOHNATHON ANTONIO MONTREL TUCKER PA (NPI 1912767674) is an individual physician assistant in Charleston, South Carolina, licensed in South Carolina (5259) and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1912767674

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameJOHNATHON ANTONIO MONTREL TUCKERCredential: PA

Location Address4 CARRIAGE LN STE 200Charleston, SC 29407-6049

Mailing Address4 Carriage Ln Ste 200Charleston, SC 29407-6049 · (843) 266-7573 · Fax (843) 266-7578

Phone(843) 266-7573

Fax(843) 266-7578

Sole ProprietorYes

Enumeration DateMarch 20, 2024

NPPES CertifiedMarch 20, 2024

✔ NPI 1912767674 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in SC · 5259

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 5259 (SC)

4 CARRIAGE LN STE 200, Charleston, SC 29407

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, BlueCross BlueShield of South Carolina and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Johnathon Antonio Montrel Tucker Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29407 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.18 typical visit price

range $53.57 – $163.84

Typical copayment $20.79 (range $13.39 – $40.96)

Most-billed visit code 99203

Established Patient

$67.12 typical visit price

range $16.96 – $133.52

Typical copayment $16.78 (range $4.24 – $33.38)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MYNDSPACE MENTAL HEALTH EDUCATION & CONSULTING, LLC

Nurse Practitioner (Psychiatric/Mental Health)