NPIMap

Individual provider Active NPI

Derek David Kestila, DO

  • Family Medicine Physician
  • Myrtle Beach, SC
National Provider Identifier
1154761252
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
83469 Issued in SC
Practice address
6010 Highway 707
Ste 100
Myrtle Beach, SC 29588-7321
Phone
(843) 234-8939
Fax
(843) 234-8959
NPI assigned
Jul 3, 2013
Last updated
May 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 83469 SC Primary

Addresses

Primary practice location

6010 Highway 707
Ste 100
Myrtle Beach, SC 29588-7321

Mailing address

300 Singleton Ridge Road
Attention PNS Credentialing
Conway, SC 29526-9142
Phone (843) 234-6946

Other practice location 1

1301 Creel Street
Conway, SC 29527-5018
Phone (843) 248-4414

Other identifiers 1

IdentifierTypeStateIssuer
834690MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160810001427 WI Practitioner - Family Practice 9234423476 Reassigns benefits to 1 organization
I20210614000572 SC Practitioner - Family Practice 9234423476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Hospital IncGroup PAC ID 7113839606, 127 clinicians

Practice addresses (Care Compare)

8004 Myrtle Trace Dr
Conway, SC 29526-8945
Phone (843) 234-8939

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
52.78 of 100Reported as group
Quality
55.48
Improvement activities
0
Cost
74.21

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital, Inc. Current Accepting new patients
Conway Hospital, Inc. CurrentSince Jul 19, 2021 Accepting new patients
Aspirus Medical Group, Inc. Current Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Jul 2, 2016 Accepting new patients
Conway Hospital, Inc. Family Medicine Past Accepting new patients
Conway Hospital, Inc. Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1301 Creel St
Conway, SC 29527
Phone (843) 248-4414

300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946

394 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 347-8050

8004 Myrtle Trace Dr
Conway, SC 29526
Phone (843) 234-8939

11899 Highway 707
Unit A8
Murrells Inlet, SC 29576
Phone (843) 651-0791

631 Bellamy Ave
Unit A
Murrells Inlet, SC 29576
Phone (843) 299-1451

2720 Plaza Dr
Ste 1400A
Wausau, WI 54401
Phone (715) 847-0426

4005 Community Center Dr
Weston, WI 54476
Phone (715) 241-5400

2031 Peach St
Wisconsin Rapids, WI 54494
Phone (715) 423-0122

410 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-5257

420 Dewey St
Wisconsin Rapids, WI 54494
Phone (715) 421-7474

Organizations & group practices 7

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1154761252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE ROAD",
            "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": "6010 HIGHWAY 707",
            "address_2": "STE 100",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887321",
            "telephone_number": "843-234-8939",
            "fax_number": "843-234-8959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Creel Street",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "SC",
            "postal_code": "295275018",
            "country_code": "US",
            "telephone_number": "843-248-4414",
            "fax_number": "843-248-3781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KESTILA",
        "first_name": "DEREK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-03",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "83469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "834690",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.