NPIMap

Organization Active NPI

Proactive MD,SC,P.a.

  • Primary Care Clinic/Center
  • North Myrtle Beach, SC
National Provider Identifier
1295563674
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PROACTIVE MD,SC,P.A.
Practice address
1120 2ND Ave S # B
North Myrtle Beach, SC 29582-3108
Phone
(864) 501-0751
NPI assigned
Jul 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

Name
Mark Allen Kemble, MD
Title
Cmo
Phone
(864) 501-0751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1120 2ND Ave S # B
North Myrtle Beach, SC 29582-3108

Mailing address

124 Allawood CT
Simpsonville, SC 29681-6207
Phone (864) 501-0751

Other names 1

  • CNMB Employee Health Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2309878CNMB Employee Health Center1120 2ND Ave South B, N Myrtle Beach, SC 29582Certificate of waiverAug 21, 2026

National Provider Directory

National Provider Directory
Tax ID family
Proactive MD Scpa19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

1120 2nd Ave S
#B
North Myrtle Beach, SC 29582
Phone (843) 366-2714

NPI Registry JSON

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

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1295563674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ALLAWOOD CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296816207",
            "telephone_number": "864-501-0751",
            "fax_number": "864-990-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 2ND AVE S # B",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295823108",
            "telephone_number": "864-501-0751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MD,SC,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-25",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "KEMBLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "864-501-0751",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CNMB Employee Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.