NPIMap

Individual provider Active NPI

Shannon Smith Tiebout, DO

  • Family Medicine Physician
  • Loris, SC
National Provider Identifier
1205488848
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
82954 Issued in SC
Practice address
3418 Casey St
Loris, SC 29569-2904
Phone
(843) 756-7885
Fax
(843) 756-7855
NPI assigned
Jul 14, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 82954 SC Primary

Addresses

Primary practice location

3418 Casey St
Loris, SC 29569-2904

Mailing address

3418 Casey St
Loris, SC 29569-2904
Phone (843) 756-7885

Other practice location 1

853 N Church St Ste 510
Spartanburg, SC 29303-3077
Phone (864) 560-1558

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
I20220802000444 SC Practitioner - Family PracticePractitioner - Urology 8224465042 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Urology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3418 Casey St
Loris, SC 29569-2904
Phone (843) 756-7885

555 E Cheves St
Florence, SC 29506-2617
Phone (843) 777-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Physician Associates II CurrentSince Aug 1, 2022 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince Sep 15, 2024 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc Family Medicine CurrentSince Sep 15, 2024 Accepting new patients
McLeod Physician Associates II Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
McLeod Loris Seacoast Hospital Past Accepting new patients

Locations

800 E Cheves St
Ste 480A
Florence, SC 29506
Phone (843) 777-7337

800 E Cheves St
Ste 240
Florence, SC 29506
Phone (843) 777-7950

506 E Cheves St
#202
Florence, SC 29506

555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233

3418 Casey St
Loris, SC 29569
Phone (843) 716-7911

Interoperability endpoints

  • Direct secure messaging: ssmith32143@directmcleodehealth.org

Organizations & group practices 5

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 6

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": "1563062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1205488848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3418 CASEY ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692904",
            "telephone_number": "843-756-7885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3418 CASEY ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692904",
            "telephone_number": "843-756-7885",
            "fax_number": "843-756-7855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "853 N Church St Ste 510",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293033077",
            "country_code": "US",
            "telephone_number": "864-560-1558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIEBOUT",
        "first_name": "SHANNON",
        "middle_name": "SMITH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-14",
        "last_updated": "2023-12-19",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "82954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loris, SC

Sources for this page

Verify at the official NPI Registry.