NPIMap

Individual provider Active NPI

Clyde P. Blalock, MD

  • Diagnostic Radiology Physician
  • Beaufort, SC
National Provider Identifier
1396782488
Registry record updated Jan 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
21036 Issued in SC
Practice address
955 Ribaut Rd
Beaufort, SC 29902-5441
Phone
(843) 522-5130
Fax
(843) 522-5538
NPI assigned
May 31, 2006
Last updated
Jan 9, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 21036 SC Primary

Addresses

Primary practice location

955 Ribaut Rd
Beaufort, SC 29902-5441

Mailing address

PO Box 49009
Greenwood, SC 29649-0001
Phone (864) 223-3070

Other identifiers 1

IdentifierTypeStateIssuer
G24901MedicaidSC

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
I20110311000383 SC Practitioner - Diagnostic Radiology 4880583434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical College of Georgia School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaufort Medical Imaging IncGroup PAC ID 6901795541, 10 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Beaufort Medical Imaging Inc Diagnostic Radiology CurrentSince May 1, 2003 Accepting new patients
The Baxley and Appling County Hospital Authority Past Accepting new patients
Chatham Radiologists, PA Diagnostic Radiology Past Accepting new patients
The Baxley and Appling County Hospital Authority Past Accepting new patients

Locations

5700 Southwyck Blvd
Toledo, OH 43614

955 Ribaut Rd
Beaufort, SC 29902
Phone (803) 522-5200

40 Palmetto Pkwy
Hilton Head Island, SC 29926
Phone (843) 681-1999

Organizations & group practices 4

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.

Hospital & facility affiliations 10

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199836800000",
    "number": "1396782488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 49009",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296490001",
            "telephone_number": "864-223-3070",
            "fax_number": "864-223-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 RIBAUT RD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "telephone_number": "843-522-5130",
            "fax_number": "843-522-5538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "CLYDE",
        "middle_name": "P.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2008-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "21036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G24901",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaufort, SC

Sources for this page

Verify at the official NPI Registry.