NPIMap

Organization Active NPI

Carolina Radiology Associates LLC

  • Diagnostic Radiology Physician
  • Conway, SC
National Provider Identifier
1225014657
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
CAROLINA RADIOLOGY ASSOCIATES LLC
Practice address
300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone
(843) 238-8660
NPI assigned
Dec 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
B Ed Shelley Jr., MD
Title
Ceo
Phone
(843) 692-0570

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X SC Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X SC

Addresses

Primary practice location

300 Singleton Ridge Rd
Conway, SC 29526-9142

Mailing address

PO Box 678904
Dallas, TX 75267-8904
Phone (843) 467-2676

Other identifiers 14

IdentifierTypeStateIssuer
89016MMMedicaidNC
890177BMedicaidNC
GP1429MedicaidSC
CC5487OtherSCRAILROAD MEDICARE
89016MHMedicaidNC
890157JMedicaidNC
GP1849MedicaidSC
89016MGMedicaidNC
5900383MedicaidNC
89016MJMedicaidNC
89016NCMedicaidNC
601119OtherSCFIRST CHOICE
89016MFMedicaidNC
GP4104MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, GA, TN, IL, FL, WI, NC, DC, KY, UT, NV, AL12 enrollments

Enrollment records 12

Enrollment IDStateProvider typePAC IDDetails
O20040714000287 SC Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 73 practitioners
Practice locations: Myrtle Beach, SC; Varnville, SC; Mullins, SC; Manning, SC; Loris, SC; North Myrtle Beach, SC; Rock Hill, SC; Timmonsville, SC…
O20210823001291 GA Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 1 practitioner
Practice locations: Kathleen, GA
O20220927004099 TN Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 1 practitioner
Practice locations: Nashville, TN
O20230214000333 IL Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 1 practitioner
Practice locations: Oak Brook, IL
O20230408000133 FL Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 5 practitioners
Practice locations: Aventura, FL; Davie, FL; Estero, FL; Hollywood, FL; Jacksonville, FL; Lakewood Ranch, FL
O20230822001342 WI Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 1 practitioner
Practice locations: Waukesha, WI
O20240405000275 NC Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 3 practitioners
Practice locations: Raleigh, NC; Corolla, NC; Chapel Hill, NC
O20240624005067 DC Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 2 practitioners
Practice locations: Alexandria, VA; Chevy Chase, MD
O20240713000162 KY Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 1 practitioner
Practice locations: Lexington, KY
O20240930000163 UT Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 1 practitioner
Practice locations: Cottonwood Heights, UT
O20250114004041 NV Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 1 practitioner
Practice locations: Henderson, NV
O20250228001983 AL Part B Supplier - Clinic/Group Practice 1658350764 Receives reassigned benefits from 4 practitioners
Practice locations: Vestavia Hills, AL; Mountain BRK, AL

National Provider Directory

National Provider Directory

Locations

801 Farrar Dr
Conway, SC 29526
Phone (843) 234-7304

800 E Cheves St
Ste 170
Florence, SC 29506
Phone (843) 777-5646

4593 Oleander Dr
Ste 200
Myrtle Beach, SC 29577

Practitioners & affiliated clinicians

Practitioners 97

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

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1134864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1225014657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 678904",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752678904",
            "telephone_number": "843-467-2676",
            "fax_number": "843-497-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-238-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA RADIOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SHELLEY",
        "authorized_official_first_name": "B",
        "authorized_official_middle_name": "ED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-692-0570",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016MM",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890177B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1429",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC5487",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016MH",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890157J",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1849",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016MG",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900383",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016MJ",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016NC",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CHOICE",
            "identifier": "601119",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016MF",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4104",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.