Active NPI
Gabriella Leary, PA-C
- Medical Physician Assistant
- Surfside Beach, SC
National Provider Identifier
1124740865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 4618PA
- Practice address
- 1413 Highway 17 N
Surfside Beach, SC 29575-6012 - Phone
- (843) 238-5654
- Fax
- (843) 238-1624
- NPI assigned
- Sep 19, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 4618PA | SC | Primary |
Addresses
Primary practice location
1413 Highway 17 N
Surfside Beach, SC 29575-6012
Mailing address
300 Singleton Ridge Rd
Attention PNS Credentialing
Conway, SC 29526-9142
Phone (843) 234-6946
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5986PA | Medicaid | SC |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
107 McLeod Health Blvd
Myrtle Beach, SC 29579-4477
Phone (843) 646-8001
Hospital & facility affiliations
- Amedisys Home Health of Myrtle Beach
- Conway Medical Center
- McLeod Loris Hospital
- Grand Strand Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 52.78 of 100
- Quality
- 55.48
- Improvement activities
- 0
- Cost
- 74.21
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conway Hospital, Inc. | Current | Accepting new patients | |
| Conway Hospital, Inc. | Current | Accepting new patients | |
| Acs Primary Care Physicians - Southeast PC | Physician Assistant | Current | Accepting new patients |
Locations
394 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 347-8050
300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946
809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182
107 McLeod Health Blvd
Myrtle Beach, SC 29579
Phone (843) 646-8001
1413 Highway 17 N
Surfside Beach, SC 29575
Phone (843) 238-5654
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 and National Provider Directory roles.
-
- Emergency Medicine Physician
- Myrtle Beach, SC
- NPI 1861430555
Physician Assistant
-
- General Acute Care Hospital
- Conway, SC
- NPI 1134172000
-
- Vascular Surgery Physician
- Conway, SC
- NPI 1134910763
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Conway, SC
- NPI 1134172000
-
- Rehabilitation Hospital Unit
- Conway, SC
- NPI 1154991487
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679270400000",
"number": "1124740865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 SINGLETON RIDGE RD",
"address_2": "ATTENTION PNS CREDENTIALING",
"city": "CONWAY",
"state": "SC",
"postal_code": "295269142",
"telephone_number": "843-234-6946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1413 HIGHWAY 17 N",
"city": "SURFSIDE BEACH",
"state": "SC",
"postal_code": "295756012",
"telephone_number": "843-238-5654",
"fax_number": "843-238-1624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEARY",
"first_name": "GABRIELLA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-19",
"last_updated": "2023-03-20",
"certification_date": "2023-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "SC",
"license": "4618PA",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5986PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Surfside Beach, SC
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.