NPIMap

Individual provider Active NPI

Michael Dennis Carr Jr., PA-C

  • Medical Physician Assistant
  • Myrtle Beach, SC
National Provider Identifier
1114108875
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1431 Issued in SC
Practice address
809 82ND Pkwy
Myrtle Beach, SC 29572-4607
Phone
(843) 497-5929
NPI assigned
Nov 21, 2007
Last updated
Jul 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1431 SC
Medical Physician Assistant 363AM0700X 1431 SC Primary

Addresses

Primary practice location

809 82ND Pkwy
Myrtle Beach, SC 29572-4607

Mailing address

PO Box 3439
North Myrtle Beach, SC 29582-0439
Phone (843) 839-4447

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
I20100722000346 SC Practitioner - Physician Assistant 8921189507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Radiology Associates LLCGroup PAC ID 1658350764, 63 clinicians

Practice addresses (Care Compare)

300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone (843) 692-0570

809 82ND Pkwy
Myrtle Beach, SC 29572-4607
Phone (843) 692-1916

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1431SCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Good Samaritan Hospital of Maryland, Inc. Past Accepting new patients
Southern Myrtle Inpatient Services, LLC Physician Assistant Past Accepting new patients

Organizations & group practices 3

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1114108875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3439",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295820439",
            "telephone_number": "843-839-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724607",
            "telephone_number": "843-497-5929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARR",
        "first_name": "MICHAEL",
        "middle_name": "DENNIS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-21",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1431",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "1431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.