NPIMap

Individual provider Active NPI

Brian Mark Melancon, APRN, FNP-C

  • Family Nurse Practitioner
  • Due West, SC
National Provider Identifier
1417526146
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
25065 Issued in SC
Practice address
6 College St
Due West, SC 29639-9554
Phone
(864) 379-2345
NPI assigned
Jun 17, 2021
Last updated
Jun 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 25065 SC Primary

Addresses

Primary practice location

6 College St
Due West, SC 29639-9554

Mailing address

313 Project Rd
Iva, SC 29655-9055
Phone (864) 616-1062

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
I20210721002136 SC Practitioner - Nurse Practitioner 1254734759 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Alabama School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6 College St
Due West, SC 29639-9554
Phone (864) 379-2345

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Edcare Consulting LLC CurrentSince Aug 29, 2021 Accepting new patients
Abbeville County Memorial Hospital Current Accepting new patients
Ich ER Services, LLC CurrentSince Aug 1, 2021 Accepting new patients
Abbeville County Memorial Hospital CurrentSince Jul 1, 2021 Accepting new patients
Abbeville County Memorial Hospital CurrentSince Jul 1, 2021 Accepting new patients
Abbeville County Memorial Hospital Past Accepting new patients

Locations

420 Thomson Cir
Abbeville, SC 29620
Phone (864) 366-1649

800 N Fant St
Anderson, SC 29621
Phone (864) 512-1000

6 College St
Due West, SC 29639
Phone (864) 379-2345

Interoperability endpoints

  • Direct secure messaging: bmelancon167534@selfregional.direct-ci.net

Organizations & group practices 6

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 7

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": "1623888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1417526146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 PROJECT RD",
            "city": "IVA",
            "state": "SC",
            "postal_code": "296559055",
            "telephone_number": "864-616-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 COLLEGE ST",
            "city": "DUE WEST",
            "state": "SC",
            "postal_code": "296399554",
            "telephone_number": "864-379-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELANCON",
        "first_name": "BRIAN",
        "middle_name": "MARK",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-17",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "25065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Due West, SC

Sources for this page

Verify at the official NPI Registry.