Beaufort County Memorial Hospital
Organization Active NPI Radiation Oncology Physician · Beaufort, SC
NPI 1174769764 · NPPES record last updated Jun 4, 2020
Key facts
- NPI
- 1174769764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Radiation Oncology Physician 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
- Organization subpart
- No
Authorized official
- Name
- Edmond Russell Baxley III
- Title
- Ceo
- Phone
- (843) 522-5140
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 10
Practitioners 201
-
Jonathan Havens Briggs, M.D.
-
John C. Chinault, M.D.
-
Joanne B Dragun, MD
-
Joseph T. Pedersen, M.D.
-
John E Sylvester, M.D.
-
Frederick Schnell Jr., M.D.
-
Clinton Amos Medbery III, M.D.
-
Paul Anthony Saconn, M.D.
-
Camilo Alcoseba, M.D.
-
Baby Ruth A Alvarez, APRN
-
Eve Anne Ashby, D.O.
-
Susanne T Baisch, FNP
-
John David Baker, DO
-
Matthew Baker, PHARMD, PA-C
-
Luke D Baxley, M.D.
-
Kimberly A Bean, NP
-
Mark Allen Bechtel, D.O.
-
Christopher B Benson, M.D.
-
Margaret E Benton, PMHNP
-
Tiffany Anne Bersani, M.D.
-
Kristin Callaghan, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Beaufort County Memorial Hospital |
Hospital | Operational/Managerial Control | Apr 3, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
122 Okatie Center Blvd N
Ste 102
Okatie, SC 29909
Phone (843) 522-7800
1680 Ribaut Rd
#A
Port Royal, SC 29935
Phone (843) 441-0487
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician |
2085R0001X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP8977 | Medicaid | SC |
Other names
- Beaufort Memorial Radiation Oncology
Other providers in Beaufort, SC
- Beaufort County Allergy
- Beaufort County Disabilities & Special Needs
- Beaufort County Memorial Hospital
- Beaufort County Memorial Hospital
- Beaufort County Memorial Hospital
- Beaufort County Memorial Hospital
- Beaufort County Memorial Hospital
- Beaufort County Memorial Hospital
- Beaufort County Memorial Hospital
- Beaufort County Memorial Hospital
All providers in Beaufort, SC · Radiation Oncology Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.