NPIMap

Individual provider Active NPI

Kevin W Shea, MD

  • Infectious Disease Physician
  • Myrtle Beach, SC
National Provider Identifier
1265474324
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
18455 Issued in SC
Practice address
920 Doug White Dr Ste 250
Myrtle Beach, SC 29572-4181
Phone
(843) 236-1950
Fax
(843) 236-1952
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 18455 SC Primary

Addresses

Primary practice location

920 Doug White Dr Ste 250
Myrtle Beach, SC 29572-4181

Mailing address

920 Doug White Dr Ste 250
Myrtle Beach, SC 29572-4181
Phone (843) 236-1950

Other identifiers 3

IdentifierTypeStateIssuer
790646CMedicaidNC
184552MedicaidSC
440001329OtherSCRAILROAD MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address KEVIN.SHEA@hca5.eclinicaldirectplus.com

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
I20091229000045 SC Practitioner - Infectious Disease 2466542733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
State University of New York - State College Optometry, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

809 82ND Pkwy
Myrtle Beach, SC 29572-4607
Phone (843) 291-7182

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Carolina Primary Care, LLC CurrentSince Oct 14, 2019 Accepting new patients

Locations

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

920 Doug White Dr
Ste 250
Myrtle Beach, SC 29572
Phone (843) 236-1950

8170 Rourk St
Ste 100
Myrtle Beach, SC 29572
Phone (843) 282-1915

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 1

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1265474324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 DOUG WHITE DR STE 250",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724181",
            "telephone_number": "843-236-1950",
            "fax_number": "843-236-1952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 DOUG WHITE DR STE 250",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724181",
            "telephone_number": "843-236-1950",
            "fax_number": "843-236-1952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "KEVIN",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2022-02-01",
        "certification_date": "2020-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "SC",
            "license": "18455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790646C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184552",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "440001329",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KEVIN.SHEA@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "920 Doug White Dr Ste 250",
            "city": "Myrtle Beach",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295724181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.