Brenda L Poalillo, APRN
Individual provider Active NPI Family Nurse Practitioner · Varnville, SC
NPI 1184145658 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1184145658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 20760 (SC)
- Practice address
- 595 W Carolina Ave
Varnville, SC 29944-4735 - Phone
- (803) 943-1217
- Fax
- (803) 943-1208
- NPI assigned
- Jul 5, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 15
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Beaufort County Memorial Hospital
Practice addresses (Care Compare)
955 Ribaut Rd
Beaufort, SC 29902-5441
Phone (843) 522-5983
Hospital & facility affiliations
- Beaufort County Memorial Hospital
- Musc Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181220002016 | SC | Practitioner - Nurse Practitioner | 8921343880 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beaufort County Memorial Hospital | Current |
Accepting new patients | |
| Southeastern Hospitalist Services PC | Current |
Accepting new patients | |
| Beaufort County Memorial Hospital | Current |
Accepting new patients | |
| Southeastern Medical Group, PC | Current |
Accepting new patients | |
| Beaufort County Memorial Hospital | Past | Accepting new patients |
Locations
260 Hospital Dr
Brevard, NC 28712
Phone (828) 883-5286
124 One Center Ct
Franklin, NC 28734
Phone (828) 369-4214
125 Hospital Dr
Spruce Pine, NC 28777
Phone (828) 765-4201
989 Ribaut Rd
Ste 103
Beaufort, SC 29902
Phone (843) 522-5351
955 Ribaut Rd
#C
Beaufort, SC 29902
955 Ribaut Rd
Beaufort, SC 29902
Phone (803) 522-5200
809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182
9330 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 554-6366
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 20760 | SC | Yes |
Addresses
Primary practice location
595 W Carolina Ave
Varnville, SC 29944-4735
Mailing address
595 W Carolina Ave
Varnville, SC 29944-4735
Phone (803) 943-1217
Other providers in Varnville, SC
- Pamela J Moore
- Morning Star Home Care Service
- Rocio Alexsandra Mundo
- Nra Varnville South Carolina LLC
- Heather Troutman Owens
- Catherine Renee Pritchard
- Antony M Rea
- Victoria R Reynolds
- Roper Saint Francis Physicians Network
- Roper Saint Francis Physicians Network
All providers in Varnville, SC · Family Nurse Practitioner 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 Jul 21, 2022. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.