NPIMap

Individual provider Active NPI

Jiajia O'Shea, D.O.

  • Emergency Medicine Physician
  • Myrtle Beach, SC
National Provider Identifier
1235424136
Registry record updated Sep 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DO37602 Issued in SC
Practice address
55 Bayberry LN
Myrtle Beach, SC 29572-5600
Phone
(978) 621-2457
NPI assigned
Jun 20, 2011
Last updated
Sep 22, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OT01397 PA
Emergency Medicine Physician 207P00000X DO37602 SC Primary

Addresses

Primary practice location

55 Bayberry LN
Myrtle Beach, SC 29572-5600

Mailing address

55 Bayberry LN
Myrtle Beach, SC 29572-5600
Phone (978) 621-2457

Other names 1

  • Dr. Jiajia Gao Former name

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
I20150520002702 SC Practitioner - Emergency Medicine 6709106420 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of New England, College of Osteo Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Hospital Emergency Professional ServicesGroup PAC ID 2163516980, 20 clinicians
Acs Primary Care Physicians - Southeast PCGroup PAC ID 5193620714, 409 clinicians

Practice addresses (Care Compare)

300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone (843) 347-7111

809 82ND Pkwy
Myrtle Beach, SC 29572-4607
Phone (843) 692-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO37602SCMDEmergency Medicine Physician
OT01397PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital Emergency Professional Services Emergency Medicine CurrentSince Jun 1, 2017 Accepting new patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine CurrentSince Jul 1, 2015 Accepting new patients

Locations

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

4000 Highway 9 E
Little River, SC 29566
Phone (843) 390-8100

3655 Mitchell St
Loris, SC 29569
Phone (843) 716-7000

809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474502400000",
    "number": "1235424136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 BAYBERRY LN",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295725600",
            "telephone_number": "978-621-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 BAYBERRY LN",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295725600",
            "telephone_number": "978-621-2457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'SHEA",
        "first_name": "JIAJIA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-20",
        "last_updated": "2016-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "OT01397",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "DO37602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JIAJIA",
            "last_name": "GAO",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.