NPIMap

Organization Active NPI

Georgetown Physician Associates, LLC

Doing business as Tidelands Health Family Medicine

  • Rural Health Clinic/Center
  • Pawley's Island, SC
National Provider Identifier
1306028832
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Doing business as
Tidelands Health Family Medicine
Practice address
9699 Ocean Hwy
Pawleys Island, SC 29585
Phone
(843) 237-4297
Fax
(843) 237-0495
NPI assigned
Nov 27, 2007
Last updated
Jun 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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

Authorized official

Name
Elizabeth Sutherland Ward
Title
Evp & Cfo
Phone
(843) 527-7102

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X SC
Primary Care Clinic/Center 261QP2300X SC
Rural Health Clinic/Center 261QR1300X SC Primary

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 names 1

  • Tidelands Health Family Medicine Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@tidelandshealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306028832. Details of each certification follow.

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
LLCNon-profit
Incorporated
Nov 7, 2012 in SC
Enrollment address
9699 Ocean Hwy
Pawleys Island, SC 29585-7425

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 30

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 30

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
42D0252166Tidelands Health Family Medicine at Pawleys Island9699 Ocean Hwy, Pawleys Island, SC 29585Provider-performed microscopyMar 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Georgetown Physician Associates16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Georgetown Hospital System Organization, Georgetown, SC Corporation, Non-profit, Chain home office Operational/Managerial Control Oct 1, 2020
Medical University Hospital Authority Organization, Charleston, SC Corporation, Management services company, Non-profit Operational/Managerial Control Oct 1, 2025
Bruce Bailey Individual Corporate OfficerEvp&Ceo Mar 29, 2002
W-2 Managing EmployeeEvp&Ceo Mar 29, 2002
Operational/Managerial Control Mar 29, 2002
Francis Ford Individual Corporate DirectorMember of Board of Directors Oct 23, 2008
Operational/Managerial ControlMember of Board of Directors Oct 23, 2008
Matthew Severence Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Gayle Resetar Individual Corporate OfficerEvp&Coo Mar 29, 2002
W-2 Managing EmployeeEvp&Coo Mar 29, 2002
Operational/Managerial ControlEvp&Coo Mar 29, 2002
Georgetown Physician Services, LLC Organization, Georgetown, SC LLC, Non-profit 5% Or Greater Direct Ownership Interest Nov 7, 2012 100%
Saju D Joy Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Daniel Scheffing Individual Corporate DirectorMember of Board of Directors Feb 17, 2011
Operational/Managerial ControlMember of Board of Directors Feb 17, 2011
Tidelands Health Holdings Organization, Georgetown, SC Corporation, Holding company, Non-profit Operational/Managerial Control Oct 1, 2020
Paul Davis Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Patrick J Cawley Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Erin Beadle Individual Corporate OfficerEvp&Cfo Jan 7, 2025
W-2 Managing EmployeeEvp&Cfo Jan 7, 2025
Operational/Managerial ControlEvp&Cfo Jan 7, 2025
Philip M Dulberger Individual Corporate OfficerEvp & Chief Physician Executive Sep 9, 2013
W-2 Managing EmployeeEvp&Cpe Sep 9, 2013
Operational/Managerial ControlEvp & Chief Physician Executive Sep 9, 2013
James Battle Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Eugene S Hong Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Charles Schulze Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Richard M Christian Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Derek Dudley Individual W-2 Managing EmployeeVP Revenue Cycle May 31, 2024
Ashley Chisolm Individual W-2 Managing EmployeeReimbursement Director Oct 1, 2025

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1306028832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421718",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294424203",
            "telephone_number": "843-520-8883",
            "fax_number": "843-652-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9699 OCEAN HWY",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "29585",
            "telephone_number": "843-237-4297",
            "fax_number": "843-237-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN PHYSICIAN ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "SUTHERLAND",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "843-527-7102"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@tidelandshealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9699 Ocean Hwy",
            "city": "Pawleys Island",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tidelands Health Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pawley's Island, SC

Sources for this page

Verify at the official NPI Registry.