Active NPI
Deanne N Geurkink, MD
- Pediatric Adolescent Medicine Physician
- Irmo, SC
National Provider Identifier
1407867351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 19500
- Practice address
- 11134 Broad River Rd
Suite D
Irmo, SC 29063-7616 - Phone
- (803) 732-0920
- Fax
- (803) 732-0920
- NPI assigned
- Aug 10, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 19500 | SC | Primary |
Addresses
Primary practice location
11134 Broad River Rd
Suite D
Irmo, SC 29063-7616
Mailing address
11134 Broad River Rd
Suite D
Irmo, SC 29063-7616
Phone (803) 732-0920
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 195005 | Medicaid | SC | |
| GP5337 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19500 | SC | MD | Pediatric Adolescent Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ballentine Pediatrics, LLC | Adolescent Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/12379/brand/1/csg/1/fhir/r4
Organizations & group practices 1
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.
-
- Pediatric Adolescent Medicine Physician
- Irmo, SC
- NPI 1629234141
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340323200000",
"number": "1407867351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11134 BROAD RIVER RD",
"address_2": "SUITE D",
"city": "IRMO",
"state": "SC",
"postal_code": "290637616",
"telephone_number": "803-732-0920",
"fax_number": "803-732-0920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11134 BROAD RIVER RD",
"address_2": "SUITE D",
"city": "IRMO",
"state": "SC",
"postal_code": "290637616",
"telephone_number": "803-732-0920",
"fax_number": "803-732-0920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GEURKINK",
"first_name": "DEANNE",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-10",
"last_updated": "2012-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "SC",
"license": "19500",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "195005",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP5337",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Irmo, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.