NPIMap

Organization Active NPI

Beaufort County Memorial Hospital

  • Radiation Oncology Physician
  • Beaufort, SC
National Provider Identifier
1174769764
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Practice address
989 Ribaut Rd Ste 130
Beaufort, SC 29902
Phone
(843) 522-7800
Fax
(843) 522-7800
NPI assigned
Jan 2, 2009
Last updated
Jun 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2020

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

Authorized official

Name
Edmond Russell Baxley III
Title
Ceo
Phone
(843) 522-5140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X Primary

Addresses

Primary practice location

989 Ribaut Rd Ste 130
Beaufort, SC 29902

Mailing address

955 Ribaut Rd
Bmac Credentialing
Beaufort, SC 29902-5441
Phone (843) 522-5785

Other practice location 1

122 Okatie Center Blvd N Ste 102
Okatie, SC 29909-3750
Phone (843) 522-7800

Other identifiers 1

IdentifierTypeStateIssuer
GP8977MedicaidSC

Other names 1

  • Beaufort Memorial Radiation Oncology Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050518001061 SC Part B Supplier - Clinic/Group Practice 7810809365 Receives reassigned benefits from 141 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Varnville, SC; Port Royal, SC; Okatie, SC; Bluffton, SC; Beaufort, SC
O20090121000511 SC Part B Supplier - Clinic/Group Practice 7810809365 Receives reassigned benefits from 10 practitioners
Practice locations: Beaufort, SC; Okatie, SC

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

122 Okatie Center Blvd N
Ste 102
Okatie, SC 29909
Phone (843) 522-7800

122 Okatie Center Blvd N
Ste 130
Okatie, SC 29909
Phone (843) 273-7980

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Beaufort County Memorial HospitalBeaufort, SC, CCN 420067 Hospital Operational/Managerial Control Apr 3, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 11

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": "1230854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1174769764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 RIBAUT RD",
            "address_2": "BMAC CREDENTIALING",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "telephone_number": "843-522-5785",
            "fax_number": "843-522-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "989 RIBAUT RD STE 130",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "29902",
            "telephone_number": "843-522-7800",
            "fax_number": "843-522-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 Okatie Center Blvd N Ste 102",
            "address_purpose": "LOCATION",
            "city": "Okatie",
            "state": "SC",
            "postal_code": "299093750",
            "country_code": "US",
            "telephone_number": "843-522-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEAUFORT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-02",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "BAXLEY",
        "authorized_official_first_name": "EDMOND",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-522-5140",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8977",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaufort Memorial Radiation Oncology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaufort, SC

Sources for this page

Verify at the official NPI Registry.