Active NPI
Amy Rose Hancock, PAC
- Medical Physician Assistant
- Myrtle Beach, SC
National Provider Identifier
1346350089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- OA002612
- Practice address
- 4900 Oleander Dr
Suite # 1
Myrtle Beach, SC 29577-5897 - Phone
- (864) 343-2609
- Fax
- (864) 546-4506
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | OA002612 | PA | Primary |
Addresses
Primary practice location
4900 Oleander Dr
Suite # 1
Myrtle Beach, SC 29577-5897
Mailing address
200 E Broad St
Suite # 220
Greenville, SC 29601-2887
Phone (864) 343-2609
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2433 | Other | SC | SOUTH CAROLINA MEDICAL LICENSE |
| PN084501L | Other | PA | PA STATE LICENSE |
Medicare participation
Medicare enrollment files- 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: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- amy.hancock.1@7857.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464825600000",
"number": "1346350089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E BROAD ST",
"address_2": "SUITE # 220",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296012887",
"telephone_number": "864-343-2609",
"fax_number": "864-546-4506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4900 OLEANDER DR",
"address_2": "SUITE # 1",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295775897",
"telephone_number": "864-343-2609",
"fax_number": "864-546-4506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANCOCK",
"first_name": "AMY",
"middle_name": "ROSE",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2016-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "OA002612",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOUTH CAROLINA MEDICAL LICENSE",
"identifier": "2433",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA STATE LICENSE",
"identifier": "PN084501L",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.