Chanda Trishaune Elzie Medlock, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4669 Issued in SC

Practice address

719 Okatie Hwy # 170
Okatie, SC 29909-3963

Phone

(843) 987-7400

NPI assigned

Jul 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EICIBD

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.

• Beaufort Jasper Hampton Comprehensive Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ridgeland, SC
  • NPI 1649276148

  SC

  Medicare reassignment NPD
• Beaufort Jasper Hampton Comprehensive Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Varnville, SC
  • NPI 1073318259
  NPD

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1073531968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 357",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299362605",
            "telephone_number": "843-987-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 OKATIE HWY # 170",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-987-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELZIE MEDLOCK",
        "first_name": "CHANDA",
        "middle_name": "TRISHAUNE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "011979",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Dickason
• DLS Homecare
• Rhonda Michelle Durham, A-GNP-C
• Christopher James Egan, PA-C
• John C. Eliassen, D.D.S.
• Fast Response Nurse Practitioners LLC
• Mary Lafrance Ferguson, M.D.
• Ines D Figueroa
• Firstchoice Healthcare PC
• Yvonne Susie Footman, RNP, MSN

• General Practice Dentistry in Okatie, SC
• Providers in Okatie, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.