NPIMap

Individual provider Active NPI

Nicholas Hagandora, FNP

  • Family Nurse Practitioner
  • Conway, SC
National Provider Identifier
1205428893
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
24654 Issued in SC
Practice address
2376 Cypress Cir Ste 102
Conway, SC 29526-8964
Phone
(843) 347-8953
Fax
(843) 347-0226
NPI assigned
Feb 5, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 24654 SC Primary

Addresses

Primary practice location

2376 Cypress Cir Ste 102
Conway, SC 29526-8964

Mailing address

300 Singleton Ridge Road
Attention Patient Accounting
Conway, SC 29526-9142
Phone (843) 234-6946

Other practice location 1

6010 Highway 707 Ste 200
Myrtle Beach, SC 29588-7321
Phone (843) 347-8953

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210412002201 SC Practitioner - Nurse Practitioner 4486062403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Hospital IncGroup PAC ID 7113839606, 127 clinicians

Practice addresses (Care Compare)

2376 Cypress Cir
Suite 102
Conway, SC 29526-8964
Phone (843) 347-8953

Hospital & facility affiliations

  • Conway Medical Center Hospital, Conway, SC, CCN 420049

Merit-based Incentive Payment System (MIPS)

Final score
52.78 of 100Reported as group
Quality
55.48
Improvement activities
0
Cost
74.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
24654SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital, Inc. CurrentSince Apr 5, 2021 Accepting new patients
Conway Hospital, Inc. Current Accepting new patients
Conway Hospital, Inc. Family CurrentSince Apr 5, 2021 Accepting new patients
Conway Hospital, Inc. Family Past Accepting new patients

Locations

2376 Cypress Cir
Ste 102
Conway, SC 29526
Phone (843) 347-8953

394 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 347-8050

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1612483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1205428893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE ROAD",
            "address_2": "ATTENTION PATIENT ACCOUNTING",
            "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": "2376 CYPRESS CIR STE 102",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268964",
            "telephone_number": "843-347-8953",
            "fax_number": "843-347-0226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6010 Highway 707 Ste 200",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295887321",
            "country_code": "US",
            "telephone_number": "843-347-8953",
            "fax_number": "843-347-0226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGANDORA",
        "first_name": "NICHOLAS",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-05",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "24654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.