Individual provider Active NPI

Brian Wesley Watson, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Myrtle Beach, SC
National Provider Identifier
1144352428
Registry record updated Nov 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
41084 Issued in SC
Practice address
809 82ND Pkwy
Myrtle Beach, SC 29572-4607
Phone
(843) 692-1495
Fax
(843) 449-6213
NPI assigned
Mar 12, 2007
Last updated
Nov 2, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 079408 GA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 0101241191 VA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 41084 SC Primary

Addresses

Primary practice location

809 82ND Pkwy
Myrtle Beach, SC 29572-4607

Mailing address

PO Box 741087
Atlanta, GA 30374-1087
Phone (843) 847-4179

Other practice location 1

3651 Wheeler Rd
Augusta, GA 30909-6521
Phone (706) 651-6544

Other practice location 2

9330 Medical Plaza Dr
Charleston, SC 29406
Phone (843) 847-4179

Other identifiers 3

IdentifierTypeStateIssuer
1144352428MedicaidVA
3810011003MedicaidWV
P00417627OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170829000601 SC Practitioner - Pathology 9335249234 Reassigns benefits to 1 organization
I20180705000596 GA Practitioner - Pathology 9335249234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Virginia Commonwealth University, School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Regional Laboratories Pathology Services, LLCGroup PAC ID 9133244346, 132 clinicians

Practice addresses (Care Compare)

3651 Wheeler Rd
Augusta, GA 30909-6521
Phone (706) 651-6544

9330 Medical Plaza Dr
Charleston, SC 29406-9104
Phone (843) 847-4179

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101241191VAMDAnatomic Pathology & Clinical Pathology Physician
0101231191VAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dunes Pathology, LLC Anatomic Pathology & Clinical Pathology Current Accepting new patients
Integrated Regional Laboratories Pathology Services, LLC Anatomic Pathology & Clinical Pathology CurrentSince Jul 17, 2017 Accepting new patients

Locations

3651 Wheeler Rd
Augusta, GA 30909
Phone (706) 651-3232

1900 Tebeau St
Waycross, GA 31501
Phone (912) 283-3030

809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182

9330 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 554-6366

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572652800000",
    "number": "1144352428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741087",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303741087",
            "telephone_number": "843-847-4179",
            "fax_number": "843-847-4296"
        },
        {
            "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": "843-692-1495",
            "fax_number": "843-449-6213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3651 Wheeler Rd",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309096521",
            "country_code": "US",
            "telephone_number": "706-651-6544",
            "fax_number": "706-651-6158",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9330 Medical Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "29406",
            "country_code": "US",
            "telephone_number": "843-847-4179",
            "fax_number": "843-847-4296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "BRIAN",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2019-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "079408",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "VA",
            "license": "0101241191",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "SC",
            "license": "41084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144352428",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810011003",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00417627",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.