NPIMap

Organization Active NPI

Edisto Regional Health Services Inc.

Doing business as William D Glenn IV MD

  • Family Medicine Physician
  • Bamberg, SC
National Provider Identifier
1366766222
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19072 Issued in SC
Legal business name
EDISTO REGIONAL HEALTH SERVICES INC.
Doing business as
William D Glenn IV MD
Practice address
498 North St
Bamberg, SC 29003-1377
Phone
(803) 245-5144
NPI assigned
Mar 22, 2010
Last updated
Jan 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Authorized official

Name
Lisa M Goodlett
Title
C.O.O.
Phone
(803) 395-2462

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19072 SC Primary

Addresses

Primary practice location

498 North St
Bamberg, SC 29003-1377

Mailing address

PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4497

Other names 1

  • William D Glenn IV MD Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810000307 SC Part B Supplier - Clinic/Group Practice 4981693447 Receives reassigned benefits from 41 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowman, SC; Bamberg, SC; Santee, SC; Saint Matthews, SC; Orangeburg, SC; Holly Hill, SC; Branchville, SC

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1269216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1366766222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161245",
            "telephone_number": "803-395-4497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "498 NORTH ST",
            "city": "BAMBERG",
            "state": "SC",
            "postal_code": "290031377",
            "telephone_number": "803-245-5144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO REGIONAL HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-22",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "GOODLETT",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "803-395-2462"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "19072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "William D Glenn IV MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bamberg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; 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.