Active NPI
Skerdilaid Licaj, P.A.
- Physician Assistant
- North Myrtle Beach, SC
National Provider Identifier
1023212842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1212
- Practice address
- 1714 Highway 17 S
North Myrtle Beach, SC 29582-4041 - Phone
- (843) 545-7200
- Fax
- (843) 545-5742
- NPI assigned
- Jun 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1212 | SC | Primary |
Addresses
Primary practice location
1714 Highway 17 S
North Myrtle Beach, SC 29582-4041
Mailing address
7603 Driftwood Dr
Myrtle Beach, SC 29572-4153
Phone (843) 692-9099
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC, NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070710000013 | SC | Practitioner - Physician Assistant | 5294835096 | Reassigns benefits to 2 organizations |
| I20171107000017 | NC | Practitioner - Physician Assistant | 5294835096 | Reassigns benefits to 5 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Musc Community Physicians
Practice addresses (Care Compare)
3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone (803) 395-3400
Hospital & facility affiliations
- McLeod Loris Hospital
- Musc Health Florence Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Musc Community Physicians | Current | Accepting new patients | |
| Musc Community Physicians | Current | Accepting new patients | |
| Musc Community Physicians | Current | Accepting new patients | |
| Franklin Regional Emergency Physicians PLLC | Current | Accepting new patients | |
| Doctors Care, PA | Past | Accepting new patients | |
| Regional Medical Center of Orangeburg and Calhoun Counties | Past | Accepting new patients | |
| Marion SC Emergency Physicians | Past | Accepting new patients | |
| Southern Living Emergency Physicians LLC | Physician Assistant | Past | Accepting new patients |
Locations
509 N Brightleaf Blvd
Smithfield, NC 27577
Phone (919) 934-8171
506 North St
Bamberg, SC 29003
Phone (803) 245-6290
805 Pamplico Hwy
Florence, SC 29505
Phone (843) 674-2500
1000 Medical Center Dr
Hardeeville, SC 29927
Phone (843) 784-8138
2829 E Highway 76
Mullins, SC 29574
Phone (843) 431-2150
3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200
Interoperability endpoints
- slicaj25446@directmcleodehealth.org
Organizations & group practices 21
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.
-
- Rural Health Clinic/Center
- Bowman, SC
- NPI 1225735772
-
- Emergency Medicine Physician
- Myrtle Beach, SC
- NPI 1861430555
SC
-
- Rural Health Clinic/Center
- Branchville, SC
- NPI 1043916448
-
- Rural Health Clinic/Center
- St Matthews, SC
- NPI 1063118461
-
- Rural Health Clinic/Center
- Orangeburg, SC
- NPI 1285330688
-
- Rural Health Clinic/Center
- Holly Hill, SC
- NPI 1508562901
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Florence, SC
- NPI 1184197683
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206921600000",
"number": "1023212842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7603 DRIFTWOOD DR",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295724153",
"telephone_number": "843-692-9099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1714 HIGHWAY 17 S",
"city": "NORTH MYRTLE BEACH",
"state": "SC",
"postal_code": "295824041",
"telephone_number": "843-545-7200",
"fax_number": "843-545-5742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICAJ",
"first_name": "SKERDILAID",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-14",
"last_updated": "2008-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "1212",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; 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.