Individual provider Active NPI

Rebecca S Eglen, MD

  • Pediatrics Physician
  • Myrtle Beach, SC
National Provider Identifier
1184623530
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
19497 Issued in SC
Practice address
6010 Highway 707
Ste 300
Myrtle Beach, SC 29588-7321
Phone
(843) 293-1005
Fax
(843) 293-1006
NPI assigned
Jul 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 19497 SC Primary

Addresses

Primary practice location

6010 Highway 707
Ste 300
Myrtle Beach, SC 29588-7321

Mailing address

300 Singleton Ridge Rd
Attention PNS Credentialing
Conway, SC 29526-9142
Phone (843) 234-6946

Other identifiers 1

IdentifierTypeStateIssuer
194970MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200330002643 SC Practitioner - Pediatric Medicine 3779912563 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19497SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital, Inc. CurrentSince Feb 3, 2020 Accepting new patients
Conway Hospital, Inc. Pediatrics CurrentSince Feb 3, 2020 Accepting new patients
Conway Hospital, Inc. Current Accepting new patients
Conway Hospital, Inc. Past Accepting new patients

Locations

300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1184623530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "address_2": "ATTENTION PNS CREDENTIALING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-234-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6010 HIGHWAY 707",
            "address_2": "STE 300",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887321",
            "telephone_number": "843-293-1005",
            "fax_number": "843-293-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGLEN",
        "first_name": "REBECCA",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "19497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194970",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.