Waccamaw Medical Services, Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

WACCAMAW MEDICAL SERVICES, INC.

Doing business as

Riegelwood Medical Clinic

Practice address

210 Highway 87
Riegelwood, NC 28456-0118

Phone

(910) 655-0021

Fax

(910) 655-2777

NPI assigned

Apr 23, 2007

Last updated

Sep 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel E Boyes, PA-CNPI 1659469195

Title

Administrator

Phone

(910) 655-0021

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Riegelwood Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417175894. Details of each certification follow.

• CCN 343911 Rural health clinic · Active · Details

Rural health clinic certification: CCN 343911

Legal name

WACCAMAW MEDICAL SERVICES, INC.

Doing business as

RIEGELWOOD MEDICAL CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 30, 1991

Last certification

Jan 22, 2016

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Nov 25, 1991 in NC

Enrollment address

210 Hwy 87
Riegelwood, NC 28456-0118

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Daniel E Boyes, PA-C

  • Medical Physician Assistant
  • Riegelwood, NC
  • NPI 1659469195

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel E Boyes, PA-C

  • Medical Physician Assistant
  • Riegelwood, NC
  • NPI 1659469195
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222041600000",
    "number": "1417175894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HWY 87",
            "city": "RIEGELWOOD",
            "state": "NC",
            "postal_code": "284560118",
            "telephone_number": "910-655-0021",
            "fax_number": "910-655-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 HIGHWAY 87",
            "city": "RIEGELWOOD",
            "state": "NC",
            "postal_code": "284560118",
            "telephone_number": "910-655-0021",
            "fax_number": "910-655-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACCAMAW MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2008-09-22",
        "status": "A",
        "authorized_official_last_name": "BOYES",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-655-0021",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343911C",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343911A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89014",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BC",
            "identifier": "1128Q",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riegelwood Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rural Health Clinic/Center in Riegelwood, NC
• Providers in Riegelwood, NC by specialty
• Rural Health Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.