Individual provider Active NPI

Courtney Freeman

  • Student in an Organized Health Care Education/Training Program
  • Myrtle Beach, SC
National Provider Identifier
1184487282
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1117 Rookery Dr
Myrtle Beach, SC 29588-7009
Phone
(304) 841-1091
NPI assigned
Feb 1, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1117 Rookery Dr
Myrtle Beach, SC 29588-7009

Mailing address

1117 Rookery Dr
Myrtle Beach, SC 29588-7009
Phone (304) 841-1091

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251226001413 WV Practitioner - Physician Assistant 7911493168 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Hospital Center IncGroup PAC ID 8123936010, 290 clinicians

Practice addresses (Care Compare)

527 Medical Park Dr
Bridgeport, WV 26330-9009
Phone (681) 342-3400

Hospital & facility affiliations

  • United Hospital Center, Inc Hospital, Bridgeport, WV, CCN 510006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3081WVMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
United Hospital Center, Inc. CurrentSince Oct 13, 2025 Accepting new patients
United Hospital Center Past Accepting new patients

Locations

527 Medical Park Dr
Ste 202
Bridgeport, WV 26330
Phone (304) 933-3850

327 Medical Park Dr
Bridgeport, WV 26330
Phone (681) 342-1000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1184487282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 ROOKERY DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887009",
            "telephone_number": "304-841-1091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 ROOKERY DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887009",
            "telephone_number": "304-841-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "COURTNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.