Georgetown Physician Associates, LLC
Organization Active NPI Rural Health Clinic/Center · Pawleys Island, SC
NPI 1306028832 · NPPES record last updated Jun 25, 2020
Key facts
- NPI
- 1306028832
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- GEORGETOWN PHYSICIAN ASSOCIATES, LLC
- Practice address
- 9699 Ocean Hwy
Pawleys Island, SC 29585 - Phone
- (843) 237-4297
- Fax
- (843) 237-0495
- NPI assigned
- Nov 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Elizabeth Sutherland Ward
- Title
- Evp & Cfo
- Phone
- (843) 527-7102
Owners & managing parties with NPI records 4
-
Eugene S Hong, MD
-
Saju Joy, MD
-
Philip M Dulberger, M.D.
Other NPIs on the same Medicare enrollment 30
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 15
Facilities with the same owner 10
Practitioners 226
-
Joanna Mazurkiewicz Chavez, FNP-BC
-
Franklin E Clemons, Jr., L.P.C.
-
Victor M Diaz-Gonzalez, M.D.
-
Michelle A Henry, OT
-
John K Ijem, M.D.
-
Brenda Starr Mihalakis, APRN
-
Kaleigh Elizabeth Seals, PA-C
-
Saint Julien Lachicotte Springs II, M.D, MHA
-
Sebastian Abadie, M.D.
-
Sara Elizabeth Adams, M.D.
-
Cecilia D Aduako, MD
-
Sheryl Kay Aiken, DNP
-
Nitesh J. Ainani, M.D
-
Michael Alvarado, MD
-
Christopher Tran Bach, M.D.
-
Brandy P Baker, P.A.
-
Ashley Tyner Baranowski, MBBS
-
Matthew Belanger, MD
-
Charmaine Eulette Belto-Mills, FNP-BC
-
Paul Wesley Benson, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0252166 | Tidelands Health Family Medicine at Pawleys Island | Provider-performed microscopy | Mar 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Rural health clinic certification: CCN 423870
- Legal name
- GEORGETOWN PHYSICIAN ASSOCIATES, LLC
- Doing business as
- TIDELANDS HEALTH FAMILY MEDICINE AT PAWLEYS ISLAND
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 18, 2010
- Last certification
- Nov 12, 2024
- Ownership / control type
- 2B
- Most recent change of ownership
- Oct 1, 2014 (1 total)
- Organization structure
- LLC · Non-profit
- Incorporated
- Nov 7, 2012 in SC
- Enrollment address
- 9699 Ocean Hwy
Pawleys Island, SC 29585-7425
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Georgetown Hospital System |
Operational/Managerial Control | Oct 1, 2020 | |
| Medical University Hospital Authority |
Operational/Managerial Control | Oct 1, 2025 | |
| Bruce Bailey |
Corporate Officer |
Mar 29, 2002 | |
| W-2 Managing Employee |
Mar 29, 2002 | ||
| Operational/Managerial Control | Mar 29, 2002 | ||
| Francis Ford |
Corporate Director |
Oct 23, 2008 | |
| Operational/Managerial Control |
Oct 23, 2008 | ||
| Matthew Severence |
Corporate Director |
Oct 1, 2025 | |
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Gayle Resetar |
Corporate Officer |
Mar 29, 2002 | |
| W-2 Managing Employee |
Mar 29, 2002 | ||
| Operational/Managerial Control |
Mar 29, 2002 | ||
| Georgetown Physician Services, LLC |
5% Or Greater Direct Ownership Interest | Nov 7, 2012 | 100% |
| Saju D Joy |
Corporate Director |
Oct 1, 2025 | |
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Daniel Scheffing |
Corporate Director |
Feb 17, 2011 | |
| Operational/Managerial Control |
Feb 17, 2011 | ||
| Tidelands Health Holdings |
Operational/Managerial Control | Oct 1, 2020 | |
| Paul Davis |
Corporate Director |
Oct 1, 2025 | |
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Patrick J Cawley |
Corporate Director |
Oct 1, 2025 | |
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Erin Beadle |
Corporate Officer |
Jan 7, 2025 | |
| W-2 Managing Employee |
Jan 7, 2025 | ||
| Operational/Managerial Control |
Jan 7, 2025 | ||
| Philip M Dulberger |
Corporate Officer |
Sep 9, 2013 | |
| W-2 Managing Employee |
Sep 9, 2013 | ||
| Operational/Managerial Control |
Sep 9, 2013 | ||
| James Battle |
Corporate Director |
Oct 1, 2025 | |
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Eugene S Hong |
Corporate Director |
Oct 1, 2025 | |
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Charles Schulze |
Corporate Director |
Oct 1, 2025 | |
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Richard M Christian |
Corporate Director |
Oct 1, 2025 | |
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Derek Dudley |
W-2 Managing Employee |
May 31, 2024 | |
| Ashley Chisolm |
W-2 Managing Employee |
Oct 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130225000067 | SC | Part B Supplier - Clinic/Group Practice | 2365697398 |
Receives reassigned benefits from 302 practitioners 30 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Murrells Inlet, SC; Myrtle Beach, SC; Pawleys Island, SC; Andrews, SC; Georgetown, SC; Hemingway, SC |
| O20150210002351 | SC | Part a Provider - Rural Health Clinic | 2365697398 | Practice locations: Pawleys Island, SC |
National Provider Directory
- Tax ID family
- Georgetown Physician Associates
Locations
1016 Huger Dr
Georgetown, SC 29440
Phone (843) 546-6158
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | SC | ||
| Primary Care Clinic/Center | 261QP2300X | SC | ||
| Rural Health Clinic/Center | 261QR1300X | SC | Yes |
Addresses
Primary practice location
9699 Ocean Hwy
Pawleys Island, SC 29585
Mailing address
PO Box 421718
Georgetown, SC 29442-4203
Phone (843) 520-8883
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RHC202 | Medicaid | SC | |
| GP6554 | Medicaid | SC |
Other names
- Tidelands Health Family Medicine
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | credentialing@tidelandshealth.org | Direct |
Other providers in Pawleys Island, SC
- Alicia Lee Garretson
- Genesis Rehab Services
- Genesis Rehabilitation Services
- Georgetown Internists and Pediatricians Inc
- Georgetown Physician Associates, LLC
- Georgetown Physician Associates, LLC
- Georgetown Physician Associates, LLC
- Georgetown Physician Services, LLC
- Georgetown Podiatry Group PC
- Gerber-Millan Womens Care LLC
All providers in Pawleys Island, SC · Rural Health Clinic/Center in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.