Individual provider Active NPI

Connor Michael Jansen, PA-C

  • Physician Assistant
  • Myrtle Beach, SC
National Provider Identifier
1245051812
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6030 Issued in SC
Practice address
210 Village Center Blvd Ste 200
Myrtle Beach, SC 29579-6706
Phone
(843) 353-3460
Fax
(843) 353-3461
NPI assigned
Oct 17, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10004566A IN
Physician Assistant 363A00000X 6030 SC Primary

Addresses

Primary practice location

210 Village Center Blvd Ste 200
Myrtle Beach, SC 29579-6706

Mailing address

210 Village Center Blvd Ste 140
Myrtle Beach, SC 29579-6706
Phone (843) 353-3460

Other practice location 1

1621 Highway 17 N
North Myrtle Beach, SC 29582-2229
Phone (843) 353-3460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241105003710 IN Practitioner - Physician Assistant 9234663881 Reassigns benefits to 2 organizations
I20251121000604 SC Practitioner - Physician Assistant 9234663881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Indiana University School of Medicine, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthosc LLCGroup PAC ID 8022370030, 113 clinicians

Practice addresses (Care Compare)

210 Village Ctr Blvd
Suite 200
Myrtle Beach, SC 29579-6706
Phone (843) 353-3460

Hospital & facility affiliations

  • Grand Strand Regional Medical Center Hospital, Myrtle Beach, SC, CCN 420085
  • McLeod Loris Hospital Hospital, Loris, SC, CCN 420105

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6030SCMDPharmacist
10004566AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthosc, LLC CurrentSince Dec 1, 2025 Accepting new patients
Orthosc, LLC CurrentSince Dec 1, 2025 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients
Orthosc, LLC PastSince May 29, 2022 Accepting new patients

Locations

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

210 Village Center Blvd
Ste 200
Myrtle Beach, SC 29579
Phone (843) 236-3222

210 Village Center Blvd
Ste 140
Myrtle Beach, SC 29579
Phone (843) 333-8385

1621 Highway 17 N
North Myrtle Beach, SC 29582
Phone (843) 335-3346

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17161/brand/1/csg/1/fhir/r4
  • Direct secure messaging: connor.jansen.1@17161.direct.athenahealth.com

Organizations & group practices 6

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 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763078400000",
    "number": "1245051812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 VILLAGE CENTER BLVD STE 140",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295796706",
            "telephone_number": "843-353-3460",
            "fax_number": "843-353-3461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 VILLAGE CENTER BLVD STE 200",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295796706",
            "telephone_number": "843-353-3460",
            "fax_number": "843-353-3461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1621 Highway 17 N",
            "address_purpose": "LOCATION",
            "city": "North Myrtle Beach",
            "state": "SC",
            "postal_code": "295822229",
            "country_code": "US",
            "telephone_number": "843-353-3460",
            "fax_number": "843-353-3461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "CONNOR",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-17",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10004566A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "6030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.