NPIMap

Organization Active NPI

Georgetown Physician Associates, LLC

Doing business as Tidelands Health Infectious Disease Specialists

  • Infectious Disease Physician
  • Georgetown, SC
National Provider Identifier
1174286777
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Doing business as
Tidelands Health Infectious Disease Specialists
Practice address
606 Black River Rd
Georgetown, SC 29440-3304
Phone
(843) 520-8020
Fax
(843) 520-8820
NPI assigned
Oct 20, 2021
Last updated
Oct 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Authorized official

Name
Elizabeth Sutherland Ward
Title
Evp & Cfo
Phone
(843) 527-7102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X Primary

Addresses

Primary practice location

606 Black River Rd
Georgetown, SC 29440-3304

Mailing address

PO Box 421718
Georgetown, SC 29442-4203
Phone (843) 652-8226

Other practice location 1

2200 Crow Ln Ste 301
Myrtle Beach, SC 29577-1663
Phone (843) 848-5350

Other names 1

  • Tidelands Health Infectious Disease Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130225000067 SC Part B Supplier - Clinic/Group Practice 2365697398 Receives reassigned benefits from 302 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Murrells Inlet, SC; Myrtle Beach, SC; Pawleys Island, SC; Andrews, SC; Georgetown, SC; Hemingway, SC

Other NPIs on the same Medicare enrollment 30

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 30

National Provider Directory

National Provider Directory
Tax ID family
Georgetown Physician Associates LLC16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1174286777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421718",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294424203",
            "telephone_number": "843-652-8226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 BLACK RIVER RD",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294403304",
            "telephone_number": "843-520-8020",
            "fax_number": "843-520-8820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Crow Ln Ste 301",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295771663",
            "country_code": "US",
            "telephone_number": "843-848-5350",
            "fax_number": "843-848-5355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GEORGETOWN PHYSICIAN ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "SUTHERLAND",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "843-527-7102"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidelands Health Infectious Disease Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.