NPIMap

Organization Active NPI

SJC Oncology Services-South Carolina, LLC

  • Radiation Oncology Physician
  • Bluffton, SC
National Provider Identifier
1306055025
Registry record updated Mar 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
SJC ONCOLOGY SERVICES-SOUTH CAROLINA, LLC
Practice address
100 Buckwalter Place Blvd Ste 150
Bluffton, SC 29910-5154
Phone
(843) 836-7120
Fax
(843) 836-7137
NPI assigned
May 21, 2007
Last updated
Mar 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2020

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

Authorized official

Name
Mr. Gregory J Schaack
Title
Cfo/VP, Finance
Phone
(912) 819-6162

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X NU
Radiation Oncology Physician 2085R0001X NU Primary
Surgical Oncology Physician 2086X0206X NU

Addresses

Primary practice location

100 Buckwalter Place Blvd Ste 150
Bluffton, SC 29910-5154

Mailing address

PO Box 11407
Dept 1623
Birmingham, AL 35246-1623
Phone (912) 352-1700

Other practice location 1

300 New River Pkwy Ste 26
Hardeeville, SC 29927-4546
Phone (843) 208-2895

Other practice location 2

25 Hospital Center Blvd.
Suite 101
Hilton Head Island, SC 29926-2738
Phone (843) 689-6490

Other practice location 3

100 Buckwalter Place Blvd Ste 120
Bluffton, SC 29910-5154
Phone (843) 836-7120

Other identifiers 4

IdentifierTypeStateIssuer
114450MedicaidSC
CC0817OtherSCRAILROAD MEDICARE
GP5359MedicaidSC
000360533AMedicaidGA

Other names 1

  • Beaufort Hilton Head Radiation Oncology Center, LP Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040429000493 SC Part B Supplier - Clinic/Group Practice 0143217273 Receives reassigned benefits from 19 practitioners
Practice locations: Bluffton, SC; Hilton Head, SC

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

100 Buckwalter Place Blvd
#1
Bluffton, SC 29910

100 Buckwalter Place Blvd
Ste 120
Bluffton, SC 29910
Phone (843) 836-7120

25 Hospital Center Blvd
Ste 101
Hilton Head Island, SC 29926
Phone (843) 689-6490

25 Hospital Center Blvd
Ste 106
Hilton Head Island, SC 29926
Phone (843) 689-5282

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1306055025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "address_2": "DEPT 1623",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352461623",
            "telephone_number": "912-352-1700",
            "fax_number": "912-352-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BUCKWALTER PLACE BLVD STE 150",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299105154",
            "telephone_number": "843-836-7120",
            "fax_number": "843-836-7137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 New River Pkwy Ste 26",
            "address_purpose": "LOCATION",
            "city": "Hardeeville",
            "state": "SC",
            "postal_code": "299274546",
            "country_code": "US",
            "telephone_number": "843-208-2895",
            "fax_number": "843-208-2896",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 Hospital Center Blvd.",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Hilton Head Island",
            "state": "SC",
            "postal_code": "299262738",
            "country_code": "US",
            "telephone_number": "843-689-6490",
            "fax_number": "843-689-6479",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Buckwalter Place Blvd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Bluffton",
            "state": "SC",
            "postal_code": "299105154",
            "country_code": "US",
            "telephone_number": "843-836-7120",
            "fax_number": "843-815-8014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SJC ONCOLOGY SERVICES-SOUTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "SCHAACK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO/VP, FINANCE",
        "authorized_official_telephone_number": "912-819-6162",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114450",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC0817",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5359",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000360533A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaufort Hilton Head Radiation Oncology Center, LP",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Beaufort Hilton Head Radiation Oncology Center, LP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bluffton, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.