NPIMap

Organization Active NPI

Beaufort County Memorial Hospital

  • Gastroenterology Physician
  • Port Royal, SC
National Provider Identifier
1235430745
Registry record updated Nov 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
31544 Issued in SC
Legal business name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Practice address
1716 Ribaut Rd
Port Royal, SC 29935-1927
Phone
(843) 522-7890
Fax
(843) 522-7889
NPI assigned
Nov 15, 2010
Last updated
Nov 6, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
BEAUFORT COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2019

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

Authorized official

Name
Mr. Edmond Russell Baxley III
Title
Ceo
Phone
(843) 522-5140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 31544 SC Primary

Addresses

Primary practice location

1716 Ribaut Rd
Port Royal, SC 29935-1927

Mailing address

1716 Ribaut Rd
Port Royal, SC 29935-1927
Phone (843) 522-7890

Other names 1

  • Beaufort Memorial Center for Digestive Diseases Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050208000354 SC Part B Supplier - Clinic/Group Practice 7810809365 Receives reassigned benefits from 229 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beaufort, SC; Okatie, SC; Varnville, SC

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Beaufort Mem Hosp

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1289779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572998400000",
    "number": "1235430745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1716 RIBAUT RD",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299351927",
            "telephone_number": "843-522-7890",
            "fax_number": "843-522-7889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1716 RIBAUT RD",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299351927",
            "telephone_number": "843-522-7890",
            "fax_number": "843-522-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUFORT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEAUFORT COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2010-11-15",
        "last_updated": "2019-11-06",
        "status": "A",
        "authorized_official_last_name": "BAXLEY",
        "authorized_official_first_name": "EDMOND",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-522-5140",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SC",
            "license": "31544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaufort Memorial Center for Digestive Diseases",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Beaufort Memorial Center for Digestive Diseases",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Royal, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; 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.