Sally Brooks Baker, MD
Individual provider Active NPI Family Medicine Physician · Conway, SC
NPI 1396196754 · NPPES record last updated Apr 23, 2021
Key facts
- NPI
- 1396196754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 84920 (SC)
- Practice address
- 300 Singleton Ridge Rd
Conway, SC 29526-9142 - Phone
- (843) 347-8103
- NPI assigned
- Jun 28, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 14
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hospital Physician Services - Southeast Professional Corporation
Practice addresses (Care Compare)
300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone (843) 347-7111
Hospital & facility affiliations
- Conway Medical Center
- Grand Strand Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201008002325 | SC | Practitioner - Family Practice | 9335434323 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 84920 | SC | MD | Family Medicine Physician |
| 59842 | TN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medicos, P.a. | Current |
Accepting new patients |
Interoperability endpoints
- sally.baker@hca5.eclinicaldirectplus.com
- https://fhir.meditouchehr.com/api/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 59842 | TN | |
| Family Medicine Physician | 207Q00000X | 84920 | SC | Yes |
Addresses
Primary practice location
300 Singleton Ridge Rd
Conway, SC 29526-9142
Mailing address
PO Box 70157
Myrtle Beach, SC 29572-0021
Phone (843) 516-2024
Other practice location 1
2323 Memorial Ave
Lynchburg, VA 24501-2661
Phone (434) 200-5200
Other practice location 2
294 Summar Dr
Jackson, TN 38301-3915
Phone (731) 423-1932
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207Q00000X | Other | VA | FAMILY MEDICINE |
NPI Registry JSON
{
"created_epoch": "1467072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1396196754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 70157",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295720021",
"telephone_number": "843-516-2024",
"fax_number": "843-796-1319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 SINGLETON RIDGE RD",
"city": "CONWAY",
"state": "SC",
"postal_code": "295269142",
"telephone_number": "843-347-8103"
}
],
"practiceLocations": [
{
"address_1": "2323 Memorial Ave",
"address_purpose": "LOCATION",
"city": "Lynchburg",
"state": "VA",
"postal_code": "245012661",
"country_code": "US",
"telephone_number": "434-200-5200",
"fax_number": "434-200-5213",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "294 Summar Dr",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "TN",
"postal_code": "383013915",
"country_code": "US",
"telephone_number": "731-423-1932",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BAKER",
"first_name": "SALLY",
"middle_name": "BROOKS",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-28",
"last_updated": "2021-04-23",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TN",
"license": "59842",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "84920",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FAMILY MEDICINE",
"identifier": "207Q00000X",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, SC
- Sarah Bach
- Amorette S Back
- Tom Badgett
- Andrew Dean Badi
- Donya T Baker
- Sivanthan Balachandran
- Heather Marie Baldassarri
- Stephanie Jayne Ball
- Sudeepthi Bandikatla
- Maria Veronica Bandres Urbina
All providers in Conway, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.