Micah Raven Bennett, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

27540 Issued in SC

Practice address

2200 Crow LN
Myrtle Beach, SC 29577-1663

Phone

(843) 848-5300

NPI assigned

Jul 5, 2023

Last updated

Jul 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Georgetown Physician Associates, LLC

  dba Tidelands Health Family Medicine

  • Family Medicine Physician
  • Murrells Inlet, SC
  • NPI 1235475930
  Medicare reassignment NPD
• Georgetown Physician Associates LLC

  dba Tidelands Health Group

  • Family Medicine Physician
  • Georgetown, SC
  • NPI 1881410587
  NPD
• Georgetown Physician Associates, LLC

  dba Tidelands Health Family Medicine

  • Family Medicine Physician
  • Murrells Inlet, SC
  • NPI 1720597743
  NPD
• Georgetown Physician Services, LLC

  dba Waccamaw Family Medicine

  • Family Medicine Physician
  • Pawley's Island, SC
  • NPI 1962691402
  NPD (past)

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1275211823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 CROW LN",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295771663",
            "telephone_number": "843-504-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 CROW LN",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295771663",
            "telephone_number": "843-848-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "MICAH",
        "middle_name": "RAVEN",
        "name_prefix": "Miss",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "27540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Hunter Bennett, MD
• Bralyn Bennett Jr., PA-C
• Hannah Daniel Bennett, LISW-CP
• Jon Michael Bennett, DO
• Jonathan Antonio Bennett Jr., MA, LPC-A
• Abbey Bensing
• Erika Benson-Levy
• Brandi Watts Benson, AA-C
• Coriana Benson
• John Edward Benson Jr.

• Family Nurse Practitioner in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.