NPIMap

Organization Active NPI

Beaufort County Memorial Hospital

  • General Practice Physician
  • Beaufort, SC
National Provider Identifier
1336180165
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Practice address
Beaufort Memorial Lowcountry Medical Group
300 Midtown
Beaufort, SC 29906-5200
Phone
(843) 770-0404
Fax
(844) 296-2308
NPI assigned
Jun 10, 2006
Last updated
Jul 9, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BEAUFORT COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Mr. Edmund Russell Baxley III
Title
Ceo
Phone
(843) 522-5140

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

Beaufort Memorial Lowcountry Medical Group
300 Midtown
Beaufort, SC 29906-5200

Mailing address

955 Ribaut Rd
Bmac Credentialing
Beaufort, SC 29902-5441
Phone (843) 522-7843

Other practice location 1

BMH Hospitalists
955 Ribaut Rd
Beaufort, SC 29902-5441
Phone (843) 522-5775

Other practice location 2

Beaufort Memorial Plastic Surgery and Aesthetics
122 Okatie Center Blvd N, Ste 220
Okatie, SC 29909
Phone (843) 707-8020

Other practice location 3

Beaufort Memorial Urology Specialists
1055 Ribaut Road, Ste 10
Beaufort, SC 29902-3402
Phone (843) 524-7607

Other practice location 4

122 Okatie Center Blvd N Ste 300
Okatie, SC 29909-3782
Phone (843) 524-7607

Other practice location 5

Beaufort Memorial Heart Specialists
300 Midtown Drive
Beaufort, SC 29906-5200
Phone (843) 770-0404

Other practice location 6

Beaufort Memorial Heart Specialists
1000 Pine Street West
Varnville, SC 29944-0969
Phone (843) 770-0404

Other practice location 7

Beaufort Memorial Oncology Specialists
989 Ribaut Rd, Ste 310
Beaufort, SC 29902-5426
Phone (843) 522-7350

Other practice location 8

Beaufort Memorial Lowcountry Medical Group
11 Arley Way, Ste 201
Bluffton, SC 29910-4883
Phone (843) 770-0404

Other practice location 9

Beaufort Memorial Heart Specialists
11 Arley Way, Ste 201
Bluffton, SC 29910-4883
Phone (843) 770-0404

Other practice location 10

Beaufort Memorial Heart Specialists-Okatie
122 Okatie Center Blvd N Suite 300
Okatie, SC 29909-3750
Phone (843) 770-0404

Other practice location 11

Beaufort Memorial Oncology Specialist-Okatie
122 Okatie Center Blvd N Ste 110
Okatie, SC 29909-3750
Phone (843) 522-7350

Other practice location 12

Beaufort Memorial Lowcountry Medical Group (GI)-Okatie
122 Okatie Center Blvd N Ste 300
Okatie, SC 29909-3750
Phone (843) 770-0404

Other identifiers 5

IdentifierTypeStateIssuer
3257OtherMEDICARE ID-TYPE UNSPECIFIED MEDICARE PART B
GP6561MedicaidSC
3257OtherMEDICARE ID-TYPE UNSPECIFIED MEDICARE PART B
101376MedicaidSC
270920MedicaidSC

Other names 1

  • Beaufort Memorial LowCountry Medical Group Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050208000354 SC Part B Supplier - Clinic/Group Practice 7810809365 Receives reassigned benefits from 229 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beaufort, SC; Okatie, SC; Varnville, SC
O20050518001061 SC Part B Supplier - Clinic/Group Practice 7810809365 Receives reassigned benefits from 141 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Varnville, SC; Port Royal, SC; Okatie, SC; Bluffton, SC; Beaufort, SC

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Part of
Beaufort Mem Hosp

Locations

122 Okatie Center Blvd N
Ste 320
Okatie, SC 29909
Phone (843) 522-7820

Practitioners & affiliated clinicians

Practitioners 115

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 115

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1336180165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 RIBAUT RD",
            "address_2": "BMAC CREDENTIALING",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "telephone_number": "843-522-7843",
            "fax_number": "843-522-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP",
            "address_2": "300 MIDTOWN",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299065200",
            "telephone_number": "843-770-0404",
            "fax_number": "844-296-2308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "BMH HOSPITALISTS",
            "address_2": "955 RIBAUT RD",
            "address_purpose": "LOCATION",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "country_code": "US",
            "telephone_number": "843-522-5775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Beaufort Memorial Plastic Surgery and Aesthetics",
            "address_2": "122 Okatie Center Blvd N, Ste 220",
            "address_purpose": "LOCATION",
            "city": "Okatie",
            "state": "SC",
            "postal_code": "29909",
            "country_code": "US",
            "telephone_number": "843-707-8020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "BEAUFORT MEMORIAL UROLOGY SPECIALISTS",
            "address_2": "1055 RIBAUT ROAD, STE 10",
            "address_purpose": "LOCATION",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299023402",
            "country_code": "US",
            "telephone_number": "843-524-7607",
            "fax_number": "833-449-4084",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "122 Okatie Center Blvd N Ste 300",
            "address_purpose": "LOCATION",
            "city": "Okatie",
            "state": "SC",
            "postal_code": "299093782",
            "country_code": "US",
            "telephone_number": "843-524-7607",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "BEAUFORT MEMORIAL HEART SPECIALISTS",
            "address_2": "300 MIDTOWN DRIVE",
            "address_purpose": "LOCATION",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299065200",
            "country_code": "US",
            "telephone_number": "843-770-0404",
            "fax_number": "844-295-9872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "BEAUFORT MEMORIAL HEART SPECIALISTS",
            "address_2": "1000 PINE STREET WEST",
            "address_purpose": "LOCATION",
            "city": "VARNVILLE",
            "state": "SC",
            "postal_code": "299440969",
            "country_code": "US",
            "telephone_number": "843-770-0404",
            "fax_number": "844-295-9872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "BEAUFORT MEMORIAL ONCOLOGY SPECIALISTS",
            "address_2": "989 RIBAUT RD, STE 310",
            "address_purpose": "LOCATION",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025426",
            "country_code": "US",
            "telephone_number": "843-522-7350",
            "fax_number": "844-296-2296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP",
            "address_2": "11 ARLEY WAY, STE 201",
            "address_purpose": "LOCATION",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299104883",
            "country_code": "US",
            "telephone_number": "843-770-0404",
            "fax_number": "844-296-2309",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "BEAUFORT MEMORIAL HEART SPECIALISTS",
            "address_2": "11 ARLEY WAY, STE 201",
            "address_purpose": "LOCATION",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299104883",
            "country_code": "US",
            "telephone_number": "843-770-0404",
            "fax_number": "844-295-9872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Beaufort Memorial Heart Specialists-Okatie",
            "address_2": "122 Okatie Center Blvd N Suite 300",
            "address_purpose": "LOCATION",
            "city": "Okatie",
            "state": "SC",
            "postal_code": "299093750",
            "country_code": "US",
            "telephone_number": "843-770-0404",
            "fax_number": "844-295-9872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "BEAUFORT MEMORIAL ONCOLOGY SPECIALIST-OKATIE",
            "address_2": "122 Okatie Center Blvd N Ste 110",
            "address_purpose": "LOCATION",
            "city": "Okatie",
            "state": "SC",
            "postal_code": "299093750",
            "country_code": "US",
            "telephone_number": "843-522-7350",
            "fax_number": "844-296-2296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Beaufort Memorial Lowcountry Medical Group (GI)-Okatie",
            "address_2": "122 Okatie Center Blvd N Ste 300",
            "address_purpose": "LOCATION",
            "city": "Okatie",
            "state": "SC",
            "postal_code": "299093750",
            "country_code": "US",
            "telephone_number": "843-770-0404",
            "fax_number": "844-296-2309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEAUFORT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEAUFORT COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-06-10",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "BAXLEY",
        "authorized_official_first_name": "EDMUND",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-522-5140",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED  MEDICARE PART B",
            "identifier": "3257",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6561",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED MEDICARE PART B",
            "identifier": "3257",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101376",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270920",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaufort Memorial LowCountry Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Beaufort Memorial LowCountry Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaufort, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.