Palmetto OBGYN LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

PALMETTO OBGYN LLC

Practice address

3864 Renee Drive
Myrtle Beach, SC 29579

Phone

(843) 353-2111

Fax

(843) 628-4326

NPI assigned

Mar 16, 2020

Last updated

Oct 16, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Olubunmi Ashabi Alo, MDNPI 1962637645

Title

MD

Phone

(843) 353-2111

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Olubunmi Ashabi Alo, M.D.

  • Obstetrics & Gynecology Physician
  • Myrtle Beach, SC
  • NPI 1962637645
  Medicare reassignment NPD Authorized official
• Ellen Lee Caughman, DNP, APRN, MSN, FNP

  • Family Nurse Practitioner
  • Myrtle Beach, SC
  • NPI 1265044267
  Medicare reassignment NPD
• Cristin Cox, CNM

  • Advanced Practice Midwife
  • Myrtle Beach, SC
  • NPI 1518761022
  Medicare reassignment NPD
• Glenda Katlin Michelle Miller, WHNP-BC

  • Women's Health Nurse Practitioner
  • Myrtle Beach, SC
  • NPI 1992538870
  Medicare reassignment NPD

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602806400000",
    "number": "1275169807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51827",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295790031",
            "telephone_number": "843-353-2111",
            "fax_number": "843-628-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3864 RENEE DRIVE",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29579",
            "telephone_number": "843-353-2111",
            "fax_number": "843-628-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO OBGYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-10-16",
        "certification_date": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALO",
        "authorized_official_first_name": "OLUBUNMI",
        "authorized_official_middle_name": "ASHABI",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "843-353-2111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP9634",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haines K Paik, M.D.
• Palmetto Human Resources LLC (Comfort Keepers)
• Palmetto Imaging, Inc (Long Bay Diagnostic Imaging)
• Palmetto Imaging, Inc (Long Bay Diagnostic Imaging)
• Palmetto Medical Clinic LLC
• Palmetto Sleep Lab LLC
• Palmetto Spine & Pain Care Consultants, LLC
• Palmetto Spine and Pain Care Consultants, LLC
• Palms Chiropractic LLC
• Heather Palomino

• Obstetrics & Gynecology Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Obstetrics & Gynecology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.