Edward L Proctor Jr., MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

10303 Issued in SC

Practice address

923 Medical Cir
Myrtle Beach, SC 29572-4116

Phone

(843) 503-5442

Fax

(843) 449-6213

NPI assigned

Jan 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Strand Gi Associates PA

  • Gastroenterology Physician
  • Myrtle Beach, SC
  • NPI 1700864519
  Medicare reassignment NPD

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465171200000",
    "number": "1316917362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "923 MEDICAL CIR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724116",
            "telephone_number": "843-503-5442",
            "fax_number": "843-449-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 MEDICAL CIR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724116",
            "telephone_number": "843-503-5442",
            "fax_number": "843-449-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "EDWARD",
        "middle_name": "L",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2016-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "SC",
            "license": "10303",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "SC",
            "license": "10303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890659V",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103033",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Pringle, LCMHC LCAS LPC CMHC
• Sarah Prinzi, M.D.
• PRN Healthcare Staffing, LC
• Proaxis Therapy SC, LLC (ATI Physical Therapy)
• Kel Z Gaskin Prock, MSR, OTR L
• Professional Counseling Associates, Inc.
• Monika C Profige
• Progressive Physical Therapy, PA (Progressive Physical Therapy Strand)
• Danielle Marie Prol, M.S.
• PRS 10, LLC (Professional Rehabilitation Services)

• Anatomic Pathology & Clinical Pathology Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Anatomic Pathology & Clinical Pathology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; 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.