NPIMap

Organization Active NPI

Georgetown Physician Associates, LLC

  • Rural Health Clinic/Center
  • Andrews, SC
National Provider Identifier
1104995372
Registry record updated May 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Practice address
701 S Morgan Ave
Andrews, SC 29510
Phone
(843) 264-5253
Fax
(843) 264-5970
NPI assigned
Nov 6, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Elizabeth Sutherland Ward
Title
Evp & Cfo
Phone
(843) 527-7102

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 15

Organizations that report the same tax identification number in the National Provider Directory.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 221

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 221

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0251623Tidelands Health Family Medicine at Andrews701 S Morgan Ave, Andrews, SC 29510Provider-performed microscopyNov 21, 2026

Medicare participation

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

Rural health clinic certification: CCN 423970

Medicare enrollment files
Legal name
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Doing business as
TIDELANDS HEALTH FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 15, 1996
Last certification
Feb 24, 2022
Ownership / control type
1B
Most recent change of ownership
Oct 1, 2014 (1 total)
Organization structure
LLCNon-profit
Incorporated
Nov 7, 2012 in SC
Enrollment address
701 S Morgan Ave
Andrews, SC 29510-2959

All disclosed owners & managing parties 20

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Georgetown Hospital System Organization, Georgetown, SC Corporation, Non-profit, Chain home office Operational/Managerial Control Oct 1, 2020
Medical University Hospital Authority Organization, Charleston, SC Corporation, Management services company, Non-profit Operational/Managerial Control Oct 1, 2025
Bruce Bailey Individual Corporate OfficerEvp&Ceo Mar 29, 2002
W-2 Managing EmployeeEvp&Ceo Mar 29, 2002
Operational/Managerial ControlEvp&Ceo Mar 29, 2002
Francis Ford Individual Corporate DirectorMember of Board of Directors Oct 23, 2008
Operational/Managerial ControlMember of Board of Directors Oct 23, 2008
Matthew Severence Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Gayle Resetar Individual Corporate OfficerEvp&Coo Mar 29, 2002
W-2 Managing EmployeeEvp&Coo Mar 29, 2002
Operational/Managerial ControlEvp&Coo Mar 29, 2002
Georgetown Physician Services, LLC Organization, Georgetown, SC LLC, Non-profit 5% Or Greater Direct Ownership Interest Nov 7, 2012
Saju D Joy Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Daniel Scheffing Individual Corporate DirectorMember of Board of Directors Feb 17, 2011
Operational/Managerial ControlMember of Board of Directors Feb 17, 2011
Tidelands Health Holdings Organization, Georgetown, SC Corporation, Holding company, Non-profit Operational/Managerial Control Oct 1, 2020
Paul Davis Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Patrick J Cawley Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Erin Beadle Individual Corporate OfficerEvp&Cfo Jan 7, 2025
W-2 Managing EmployeeEvp&Cfo Jan 7, 2025
Operational/Managerial ControlEvp&Cfo Jan 7, 2025
Philip M Dulberger Individual Corporate OfficerEvp & Chief Physician Executive Sep 9, 2013
W-2 Managing EmployeeEvp & Chief Physician Executive Sep 9, 2013
Operational/Managerial ControlEvp & Chief Physician Executive Sep 9, 2013
James Battle Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Eugene S Hong Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Charles Schulze Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Richard M Christian Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Derek Dudley Individual W-2 Managing EmployeeVP Revenue Cycle May 31, 2024
Ashley Chisolm Individual W-2 Managing EmployeeReimbursement Director Oct 1, 2025

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20141021001385 SC Part a Provider - Rural Health Clinic 2365697398 Practice locations: Andrews, SC

National Provider Directory

National Provider Directory
Tax ID family
Georgetown Physician Associates (16 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

701 S Morgan Ave
Andrews, SC 29510

Mailing address

PO Box 421718
Georgetown, SC 29442-4203
Phone (843) 520-8330

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
RHC068MedicaidSC

Other names 1

NPPES NPI Registry
  • Tidelands Health Family Medicine Doing business as

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
Other URL WWW.TIDELANDSHEALTH.ORG

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 1, 2020.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1104995372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421718",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294424203",
            "telephone_number": "843-520-8330",
            "fax_number": "843-652-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 S MORGAN AVE",
            "city": "ANDREWS",
            "state": "SC",
            "postal_code": "29510",
            "telephone_number": "843-264-5253",
            "fax_number": "843-264-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN PHYSICIAN ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "SUTHERLAND",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "843-527-7102"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC068",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "WWW.TIDELANDSHEALTH.ORG",
            "affiliation": "N",
            "address_1": "701 S Morgan Ave",
            "city": "Andrews",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tidelands Health Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Andrews, SC

Sources for this page

Verify at the official NPI Registry.