Individual provider Active NPI

Donnell Ramsey Mace, FNP

  • Nurse Practitioner
  • North Myrtle Beach, SC
National Provider Identifier
1366547507
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
25840 Issued in SC
Practice address
800 25TH Ave S Ste 12
North Myrtle Beach, SC 29582-4320
Phone
(843) 256-6721
Fax
(843) 900-2200
NPI assigned
Sep 13, 2006
Last updated
Apr 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 005001277 NC
Family Nurse Practitioner 363LF0000X 132174 NC
Nurse Practitioner 363L00000X 25840 SC Primary

Addresses

Primary practice location

800 25TH Ave S Ste 12
North Myrtle Beach, SC 29582-4320

Mailing address

503 20TH Ave N Unit 27D
North Myrtle Beach, SC 29582-2383
Phone (828) 403-5907

Other practice location 1

1714 Highway 17 S
North Myrtle Beach, SC 29582-4041
Phone (843) 361-0705

Other identifiers 2

IdentifierTypeStateIssuer
8919642MedicaidNC
19642OtherNCBC

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240215002424 SC Practitioner - Nurse Practitioner 8022452234 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
005001277NCMDFamily Medicine Physician
132174NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Palms Health & Wellness LLC CurrentSince Jul 21, 2024 Accepting new patients
Novant Health Urgent Cares LLC Family Medicine CurrentSince Nov 1, 2024 Accepting new patients

Locations

6167 Braided Mane Pass SW
Aiken, SC 29803
Phone (803) 502-1484

100 Jimmy Love Ln
Columbia, SC 29212
Phone (803) 731-4055

1113 Church St
Conway, SC 29526
Phone (843) 248-6269

1714 Highway 17 S
North Myrtle Beach, SC 29582
Phone (803) 238-1461

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1366547507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 20TH AVE N UNIT 27D",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295822383",
            "telephone_number": "828-403-5907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 25TH AVE S STE 12",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295824320",
            "telephone_number": "843-256-6721",
            "fax_number": "843-900-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1714 Highway 17 S",
            "address_purpose": "LOCATION",
            "city": "North Myrtle Beach",
            "state": "SC",
            "postal_code": "295824041",
            "country_code": "US",
            "telephone_number": "843-361-0705",
            "fax_number": "843-361-4045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACE",
        "first_name": "DONNELL",
        "middle_name": "RAMSEY",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "005001277",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "132174",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "25840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8919642",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "19642",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.