Individual provider Active NPI

Misty Danelle Polston Whipkey, NP

  • Dermatology Physician
  • Myrtle Beach, SC
National Provider Identifier
1124556584
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
21023 Issued in SC
Practice address
917 Medical Cir
Myrtle Beach, SC 29572-4116
Phone
(843) 449-0453
NPI assigned
May 30, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 21023 SC
Dermatology Physician 207N00000X 21023 SC Primary

Addresses

Primary practice location

917 Medical Cir
Myrtle Beach, SC 29572-4116

Mailing address

917 Medical Cir
Myrtle Beach, SC 29572-4116
Phone (843) 449-0453

Other names 1

  • Misty Danelle Polston Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170914000498 SC Practitioner - Nurse Practitioner 6305110396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Waccamaw Dermatology LLCGroup PAC ID 7315021169, 26 clinicians

Practice addresses (Care Compare)

917 Medical Cir
Myrtle Beach, SC 29572-4116
Phone (843) 449-0453

Merit-based Incentive Payment System (MIPS)

Final score
90.01 of 100Reported as group
Quality
100
Improvement activities
40
Cost
66.69

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Waccamaw Dermatology, LLC Dermatology CurrentSince Jul 13, 2017 Accepting new patients
Coastal Kidney Center PA PastSince Jul 1, 2017 Accepting new patients

Locations

2725 Iron Gate Dr
Ste 100
Wilmington, NC 28412

834 Farrar Dr
Conway, SC 29526
Phone (843) 347-9487

166 Waccamaw Medical Park Ct
Conway, SC 29526
Phone (843) 449-8079

705 N 8th Ave
Ste 3B
Dillon, SC 29536
Phone (843) 841-3825

505 Belle Hall Pkwy
Unit 202
Mt Pleasant, SC 29464

5046 Highway 17 Byp S
Ste 200
Myrtle Beach, SC 29588
Phone (843) 839-3501

8170 Rourk St
Ste 100
Myrtle Beach, SC 29572
Phone (843) 282-1915

8170 Rourk St
Ste 175
Myrtle Beach, SC 29572

917 Medical Cir
Myrtle Beach, SC 29572

5046 Highway 17 Byp S
Ste 203
Myrtle Beach, SC 29588
Phone 8432941941310

14880 Ocean Hwy
Pawleys Island, SC 29585
Phone (843) 237-1569

5500 Front St
Ste 260
Summerville, SC 29486

Interoperability endpoints

  • Direct secure messaging: mpolston@directaddress.net

Organizations & group practices 2

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": "1496102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1124556584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 MEDICAL CIR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724116",
            "telephone_number": "843-449-0453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 MEDICAL CIR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724116",
            "telephone_number": "843-449-0453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLSTON WHIPKEY",
        "first_name": "MISTY",
        "middle_name": "DANELLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-30",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "21023",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SC",
            "license": "21023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISTY",
            "last_name": "POLSTON",
            "middle_name": "DANELLE",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.