Individual provider Active NPI

Stephen Hanneken, PA-C

  • Medical Physician Assistant
  • Myrtle Beach, SC
National Provider Identifier
1073632022
Registry record updated Nov 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MPA.5574 Issued in SC
Practice address
2510 N Kings Hwy
Myrtle Beach, SC 29577-3037
Phone
(843) 626-2273
NPI assigned
Mar 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MPA.5574 SC Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

2510 N Kings Hwy
Myrtle Beach, SC 29577-3037

Mailing address

2510 N Kings Hwy
Myrtle Beach, SC 29577-3037
Phone (843) 626-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080227000206 NJ Practitioner - Physician Assistant 8022192236 Reassigns benefits to 3 organizations
I20250117000143 SC Practitioner - Physician Assistant 8022192236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Carenow Urgent Care LLCGroup PAC ID 3274893359, 72 clinicians

Practice addresses (Care Compare)

1316 3Rd Ave
Conway, SC 29526-5002
Phone (843) 488-7283

2510 N Kings Hwy
Myrtle Beach, SC 29577-3037
Phone (843) 626-2273

515 Saint James Ave
Goose Creek, SC 29445-2794
Phone (843) 507-8925

817 10TH Ave S
Surfside Beach, SC 29575-3222
Phone (843) 839-7283

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MPA.5574SCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Beach Urgent Care CurrentSince Dec 22, 2024 Accepting new patients
Patients First Maryland Physicians Group P C CurrentSince Sep 17, 2019 Accepting new patients
Patient First Maryland Physician'S Group PC CurrentSince Sep 17, 2019 Accepting new patients
East PA Emergency Physicians, LLC Past Accepting new patients
Emergency Care Services of Pennsylvania, P.C. Physician Assistant Past Accepting new patients

Locations

2171 Route 70 W
Cherry Hill, NJ 08002
Phone (856) 406-0023

630 Mantua Pike
Woodbury, NJ 08096
Phone (856) 812-2220

2510 N Kings Hwy
Myrtle Beach, SC 29577
Phone (843) 626-2273

5000 Cox Rd
Glen Allen, VA 23060
Phone (804) 822-4355

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763164800000",
    "number": "1073632022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 N KINGS HWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295773037",
            "telephone_number": "843-626-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 N KINGS HWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295773037",
            "telephone_number": "843-626-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNEKEN",
        "first_name": "STEPHEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2025-11-15",
        "certification_date": "2025-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "MPA.5574",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.