James Louis Dedonis, MD
Individual provider Active NPI Cardiovascular Disease Physician · Mullins, SC
NPI 1073536744 · NPPES record last updated Sep 30, 2014
Key facts
- NPI
- 1073536744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 20887 (SC)
- Practice address
- 2835 E Highway 76 Ste 5
Mullins, SC 29574-6038 - Phone
- (843) 431-2171
- Fax
- (843) 431-2999
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101203000970 | SC | Practitioner - Internal Medicine |
7810184710 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Family Care, Inc | Current |
Accepting new patients | |
| Carolina Family Care, Inc | Current |
Accepting new patients | |
| Advanced Cardiology Consultants | Cardiovascular Disease | Past |
Accepting new patients |
Locations
805 Pamplico Hwy
Ste 300
Florence, SC 29505
Phone (843) 679-2760
1925 Hoffmeyer Rd
Florence, SC 29501
Phone (843) 661-4390
1341 Old Georgetown Rd
Ste C
Mt Pleasant, SC 29464
Phone (843) 884-2175
2845 E Highway 76
Ste 3
Mullins, SC 29574
Phone (843) 431-2730
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EIGABA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 20887 | SC | Yes |
Addresses
Primary practice location
2835 E Highway 76 Ste 5
Mullins, SC 29574-6038
Mailing address
2835 E Highway 76 Ste 5
Mullins, SC 29574-6038
Phone (843) 431-2171
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP0965 | Medicaid | SC |
Other providers in Mullins, SC
- D & Z Community Center Inc
- Corrie Maria Davis
- Parmanand Dawani
- Robert Louis De Grood
- Jeromy Deakins
- Dhec
- Bryan Dickison
- Okechukwu Dimkpa
- Eagle Nursing LLC
- Mitchell E Falk
All providers in Mullins, SC · Cardiovascular Disease Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.