NPIMap

Organization Active NPI

Beach Anesthesia, LLC

  • Anesthesiology Physician
  • Myrtle Beach, SC
National Provider Identifier
1215061429
Registry record updated Oct 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
BEACH ANESTHESIA, LLC
Practice address
1021 Medical Circle
Suite 100
Myrtle Beach, SC 29572
Phone
(843) 692-1062
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2007

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

Authorized official

Name
Joseph A. Maggioncalda, MDNPI 1578658944
Title
President
Phone
(843) 692-1062

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

1021 Medical Circle
Suite 100
Myrtle Beach, SC 29572

Mailing address

PO Box 7276
Columbia, SC 29202
Phone (803) 765-1838

Other identifiers 1

IdentifierTypeStateIssuer
GP4651MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070530000620 SC Part B Supplier - Clinic/Group Practice 6103924014 Receives reassigned benefits from 270 practitioners
Practice locations: West Columbia, SC; Sumter, SC; Orangeburg, SC; Newberry, SC; Myrtle Beach, SC; Mt Pleasant, SC; Columbia, SC; Chapin, SC…

National Provider Directory

National Provider Directory

Locations

145 Park Central Dr
Columbia, SC 29203
Phone (803) 736-3277

1930 Blanding St
Columbia, SC 29201
Phone (803) 461-4740

1625 Hospital Dr
Mt Pleasant, SC 29464
Phone (866) 774-6350

Practitioners & affiliated clinicians

Practitioners 297

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 297

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1215061429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7276",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29202",
            "telephone_number": "803-765-1838",
            "fax_number": "803-765-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 MEDICAL CIRCLE",
            "address_2": "SUITE 100",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29572",
            "telephone_number": "843-692-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "MAGGIONCALDA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-692-1062",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4651",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.