NPIMap

Individual provider Active NPI

Tricia L Etheridge, M.D.

  • General Practice Physician
  • Ridgeland, SC
National Provider Identifier
1366531162
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
19547 Issued in SC
Practice address
109 S Green St
Ridgeland, SC 29936-9165
Phone
(843) 726-6773
Fax
(843) 726-6778
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 19547 SC Primary

Addresses

Primary practice location

109 S Green St
Ridgeland, SC 29936-9165

Mailing address

109 S Green St
Ridgeland, SC 29936-9165
Phone (843) 726-6773

Other identifiers 6

IdentifierTypeStateIssuer
320114664OtherSCBLUE CROSS BLUE SHIELD
42D1028556OtherSCCLIA
DC4084OtherSCRAIL ROAD MEDICARE
320114664OtherSCTAX ID
19547OtherSCLICENSE #
L25587MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040722000058 SC Practitioner - Family Practice 2668452806 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SJC Medical Group IncGroup PAC ID 7719978105, 57 clinicians

Practice addresses (Care Compare)

109 S Green St
Ridgeland, SC 29936-9165
Phone (843) 726-6773

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19547SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
SJC Medical Group Inc CurrentSince Jan 2, 2018 Accepting new patients
University Medical Associates of the Medical University of South Carol Past Accepting new patients
Saint Josephs Medical Group Inc Past Accepting new patients

Locations

602 E 72nd St
Savannah, GA 31405
Phone (912) 819-7800

10 Oak Forest Rd
Ste C
Bluffton, SC 29910
Phone (843) 785-7515

109 S Green St
Ridgeland, SC 29936
Phone (843) 726-6773

Interoperability endpoints

  • Direct secure messaging: ethtrl@direct.sjchs.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/EGDCBD
  • Direct secure messaging: tricia.etheridge@sjcmg.eclinicaldirectplus.com

Organizations & group practices 3

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1366531162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 S GREEN ST",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299369165",
            "telephone_number": "843-726-6773",
            "fax_number": "843-726-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S GREEN ST",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299369165",
            "telephone_number": "843-726-6773",
            "fax_number": "843-726-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "TRICIA",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "SC",
            "license": "19547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "320114664",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "42D1028556",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DC4084",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "320114664",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "19547",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L25587",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, SC

Sources for this page

Verify at the official NPI Registry.