NPIMap

Individual provider Active NPI

Fletcher Carl Derrick III, M.D.

  • Internal Medicine Physician
  • Beaufort, SC
National Provider Identifier
1083784110
Registry record updated Jul 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18476 Issued in SC
Practice address
Beaufort Memorial Lowcountry Medical Group
300 Midtown Dr
Beaufort, SC 29906-5200
Phone
(843) 770-0404
Fax
(844) 296-2308
NPI assigned
Nov 8, 2006
Last updated
Jul 24, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18476 SC Primary

Addresses

Primary practice location

Beaufort Memorial Lowcountry Medical Group
300 Midtown Dr
Beaufort, SC 29906-5200

Mailing address

955 Ribaut Rd
Bmac Credentialing
Beaufort, SC 29902-5441
Phone (843) 522-5674

Other identifiers 1

IdentifierTypeStateIssuer
184767MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050919000598 SC Practitioner - Internal Medicine 2062446164 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical University of South Carolina College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Beaufort County Memorial HospitalGroup PAC ID 7810809365, 197 clinicians
Southeastern Hospitalist Services PCGroup PAC ID 3476855420, 301 clinicians

Practice addresses (Care Compare)

300 Midtown Dr
Beaufort, SC 29906-5200
Phone (843) 770-0404

501 Robertson Blvd
Walterboro, SC 29488-2787
Phone (843) 782-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.95 of 100Reported as group
Quality
83.15
Promoting interoperability
100
Improvement activities
40
Cost
73.35

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
18476SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Hospitalist Services PC Internal Medicine CurrentSince Jan 1, 2016 Accepting new patients
Coastal Inpatient Physicians, LLC Internal Medicine CurrentSince Jun 15, 2009 Accepting new patients
24 On Physicians, PC CurrentSince Mar 7, 2007 Accepting new patients
South Carolina Group Services, LLC CurrentSince Sep 1, 2013 Accepting new patients
24 On Physicians, P.C. CurrentSince Mar 7, 2007 Accepting new patients
Beaufort County Memorial Hospital CurrentSince Mar 1, 2014 Accepting new patients
Beaufort County Memorial Hospital Past Accepting new patients
Beaufort County Memorial Hospital Past Accepting new patients
Orthopedic Associates of the Lowcountry, LLC Internal Medicine Past Accepting new patients
Colleton Medical Anesthesia, LLC Past Accepting new patients
Lowcountry Medical Associates Past Accepting new patients
Lowcountry Medical Associates Internal Medicine Past Accepting new patients
Colleton Medical Hospitalists LLC Past Accepting new patients

Locations

300 Midtown Dr
Beaufort, SC 29906
Phone (843) 379-7746

955 Ribaut Rd
Beaufort, SC 29902
Phone (803) 522-5200

955 Ribaut Rd
#C
Beaufort, SC 29902

989 Ribaut Rd
Ste 103
Beaufort, SC 29902
Phone (843) 522-5351

990 Ribaut Rd
Ste 112
Beaufort, SC 29902
Phone (843) 524-6121

1000 Medical Center Dr
Hardeeville, SC 29927
Phone (843) 784-8138

25 Hospital Ctr
Hilton Head Island, SC 29926
Phone (843) 682-2345

25 Hospital Ctr
Ste 300
Hilton Head Island, SC 29926
Phone (843) 681-8203

2000 Hospital Dr
Mt Pleasant, SC 29464
Phone (803) 533-2200

809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182

9330 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 554-6366

501 Robertson Blvd
Walterboro, SC 29488
Phone (843) 549-2000

Interoperability endpoints

  • Direct secure messaging: fletcher.derrick.1@16436.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sprenger Healthcare of Port RoyalPort Royal, SC, CCN 425413 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2018
May 1, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563926400000",
    "number": "1083784110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 RIBAUT RD",
            "address_2": "BMAC CREDENTIALING",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "telephone_number": "843-522-5674",
            "fax_number": "843-522-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP",
            "address_2": "300 MIDTOWN DR",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299065200",
            "telephone_number": "843-770-0404",
            "fax_number": "844-296-2308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "FLETCHER",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2019-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "18476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184767",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaufort, SC

Sources for this page

Verify at the official NPI Registry.