NPIMap

Individual provider Active NPI

Shannon Marie Philipps, DO

  • Sports Medicine (Family Medicine) Physician
  • Surfside Beach, SC
National Provider Identifier
1215490776
Registry record updated Nov 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
93574 Issued in SC
Practice address
1413 Highway 17 N
Surfside Beach, SC 29575-6012
Phone
(843) 347-8041
Fax
(843) 347-8042
NPI assigned
Apr 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 93574 SC Primary

Addresses

Primary practice location

1413 Highway 17 N
Surfside Beach, SC 29575-6012

Mailing address

300 Singleton Ridge Rd
Attention Credentialing
Conway, SC 29526-9142

Other practice location 1

6010 Highway 707 Ste 300
Myrtle Beach, SC 29588-7321
Phone (843) 347-8041

Other practice location 2

1100 62nd Ave N
Myrtle Beach, SC 29572-7202
Phone (843) 347-8041

Other practice location 3

8004 Myrtle Trace Dr Ste 200
Conway, SC 29526-8945
Phone (843) 347-8041

Other identifiers 1

IdentifierTypeStateIssuer
935741MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240105003546 GA Practitioner - Sports MedicinePractitioner - Family Practice 8224363049
I20250312000176 SC Practitioner - Sports MedicinePractitioner - Family Practice 8224363049 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
Philadelphia Col of Osteo Med, Sewanee, 2019
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)

6010 Hwy 707
Suite 300
Myrtle Beach, SC 29588-7321
Phone (843) 293-1005

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital, Inc. CurrentSince Mar 15, 2025 Accepting new patients
Conway Hospital, Inc. CurrentSince Mar 15, 2025 Accepting new patients
Conway Hospital, Inc. Past Accepting new patients
Conway Hospital, Inc. Sports Medicine Past Accepting new patients

Locations

8004 Myrtle Trace Dr
Ste 200
Conway, SC 29526
Phone (843) 347-8041

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

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

2376 Cypress Cir
Ste 300
Conway, SC 29526
Phone (843) 347-7222

1100 62nd Ave N
Myrtle Beach, SC 29572
Phone (843) 347-8041

1413 Highway 17 N
Surfside Beach, SC 29575
Phone (843) 238-5654

Interoperability endpoints

  • Direct secure messaging: shannon.philipps.1@8967.direct.athenahealth.com

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": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763683200000",
    "number": "1215490776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "address_2": "ATTENTION CREDENTIALING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 HIGHWAY 17 N",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295756012",
            "telephone_number": "843-347-8041",
            "fax_number": "843-347-8042"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6010 Highway 707 Ste 300",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295887321",
            "country_code": "US",
            "telephone_number": "843-347-8041",
            "fax_number": "843-347-8042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 62nd Ave N",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295727202",
            "country_code": "US",
            "telephone_number": "843-347-8041",
            "fax_number": "843-347-8042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8004 Myrtle Trace Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "SC",
            "postal_code": "295268945",
            "country_code": "US",
            "telephone_number": "843-347-8041",
            "fax_number": "843-347-8042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILIPPS",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "SC",
            "license": "93574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "935741",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Surfside Beach, SC

Sources for this page

Verify at the official NPI Registry.