Thomas O Fort, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

780 Issued in SC

Practice address

701 S Morgan Ave
Andrews, SC 29510-2959

Phone

(843) 264-5253

Fax

(843) 264-5970

NPI assigned

Dec 29, 2005

Last updated

Jun 16, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Georgetown Physician Associates, LLC

  dba Tidelands Health Family Medicine

  • Family Medicine Physician
  • Murrells Inlet, SC
  • NPI 1235475930
  Medicare reassignment
• Georgetown Physician Associates LLC

  dba Tidelands Health Group

  • Family Medicine Physician
  • Georgetown, SC
  • NPI 1881410587
  NPD
• Georgetown Physician Associates, LLC

  dba Tidelands Health Family Medicine

  • Rural Health Clinic/Center
  • Pawley's Island, SC
  • NPI 1306028832
  NPD
• Georgetown Physician Services, LLC

  dba Waccamaw Family Medicine

  • Family Medicine Physician
  • Pawley's Island, SC
  • NPI 1962691402
  NPD (past)

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1144207382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1209",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295761209",
            "telephone_number": "843-652-8220",
            "fax_number": "843-527-7080"
        },
        {
            "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": "295102959",
            "telephone_number": "843-264-5253",
            "fax_number": "843-264-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORT",
        "first_name": "THOMAS",
        "middle_name": "O",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC068",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeanne Singleton Caison, NP
• Selena Augustine Chamberlain, APRN
• Charles B Jones
• Janet Leigha Cooper, SLP
• Bryan Dry
• Georgetown Health Group (Andrews Medical Center)
• Georgetown Memorial Hospital (Andrews Medical Center Pediatric Rehab)
• Georgetown Physician Associates, LLC (Tidelands Health Family Medicine)
• Abigail Haddock
• Tracey Haddock

• Medical Physician Assistant in Andrews, SC
• Providers in Andrews, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.