NPIMap

Organization Active NPI

Beaufort County Memorial Hospital

  • General Acute Care Hospital
  • Beaufort, SC
National Provider Identifier
1366436073
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
HTL026 Issued in SC
Legal business name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Practice address
955 Ribaut Road
Beaufort, SC 29902-5454
Phone
(843) 522-5200
Fax
(843) 522-5765
NPI assigned
Sep 8, 2005
Last updated
Aug 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HTL026 SC Primary

Addresses

Primary practice location

955 Ribaut Road
Beaufort, SC 29902-5454

Mailing address

955 Ribaut Road
Beaufort, SC 29902-5441
Phone (843) 522-5200

Other practice location 1

1680 Ribaut Rd Ste B
Port Royal, SC 29935-2008
Phone (843) 522-5775

Other practice location 2

989 Ribaut Rd Ste 103
Beaufort, SC 29902-5472
Phone (843) 522-5351

Other identifiers 4

IdentifierTypeStateIssuer
270920MedicaidSC
400676MedicaidSC
101376MedicaidSC
DPE033MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050622000128 SC Part A Provider - Hospital 7810809365 Practice locations: Bluffton, SC; Port Royal, SC; Okatie, SC; Hilton Head, SC; Beaufort, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366436073. Details of each certification follow.

Hospital certification: CCN 420067

Legal name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jun 8, 1967
Last certification
Jun 8, 2018
Beds
197
Ownership / control type
Local
Organization structure
OtherNon-profit
Incorporated
in SC
Enrollment address
955 Ribaut Rd
Beaufort, SC 29902-5441
Other Hospital Practice Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Beaufort County Memorial HospitalCCN 420067 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Beaufort Memorial Hospital16 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

Locations

1033 Ribaut Rd
Beaufort, SC 29902
Phone (843) 322-5800

1680 Ribaut Rd
#B
Port Royal, SC 29935
Phone (843) 522-5775

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Allison C Coppage JD Individual Corporate OfficerCompliance Officer Apr 3, 2017
Kenneth Miller Individual Corporate OfficerSenior VP and Cfo Dec 5, 2016
Shawna H Doran Individual W-2 Managing EmployeeVP Quality/Risk Sep 1, 2017
Edmond Baxley Individual Corporate OfficerPresident and Ceo Sep 12, 2016
Beaufort County Memorial Hospital Organization, Beaufort, SC Non-profit Operational/Managerial Control Apr 3, 2017
Trimmell Simmons Individual W-2 Managing Employee Dec 18, 2019

Owners & managing parties with NPI records 10

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

Affiliated clinicians 705

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 705

NPI Registry JSON

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1366436073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 RIBAUT ROAD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "telephone_number": "843-522-5200",
            "fax_number": "843-522-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 RIBAUT ROAD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025454",
            "telephone_number": "843-522-5200",
            "fax_number": "843-522-5765"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1680 Ribaut Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Port Royal",
            "state": "SC",
            "postal_code": "299352008",
            "country_code": "US",
            "telephone_number": "843-522-5775",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "989 Ribaut Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Beaufort",
            "state": "SC",
            "postal_code": "299025472",
            "country_code": "US",
            "telephone_number": "843-522-5351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEAUFORT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "BAXLEY",
        "authorized_official_first_name": "EDMOND",
        "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": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "SC",
            "license": "HTL026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270920",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400676",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101376",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DPE033",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaufort, SC

Sources for this page

Verify at the official NPI Registry.