Organization Active NPI

Newberry Surgical LLC

  • Surgery Physician
  • Newberry, SC
National Provider Identifier
1073072468
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
NEWBERRY SURGICAL LLC
Practice address
2660 Kinard St
Newberry, SC 29108-2912
Phone
(912) 278-4819
NPI assigned
Mar 15, 2019
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
William H Cantey, MDNPI 1164427811
Title
Owner/Employee
Phone
(912) 278-4819

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
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

2660 Kinard St
Newberry, SC 29108-2912

Mailing address

2660 Kinard St
Newberry, SC 29108-2912
Phone (803) 597-5225

Other identifiers 1

IdentifierTypeStateIssuer
188175MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190516003168 SC Part B Supplier - Clinic/Group Practice 3971846825 Receives reassigned benefits from 1 practitioner
Practice locations: Newberry, SC

National Provider Directory

National Provider Directory

Locations

2660 Kinard St
Newberry, SC 29108
Phone (803) 405-9911

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1073072468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2660 KINARD ST",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "291082912",
            "telephone_number": "803-597-5225",
            "fax_number": "803-597-5228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2660 KINARD ST",
            "city": "NEWBERRY",
            "state": "SC",
            "postal_code": "291082912",
            "telephone_number": "912-278-4819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWBERRY SURGICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-15",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "CANTEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/EMPLOYEE",
        "authorized_official_telephone_number": "912-278-4819",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188175",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newberry, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.