Anthony Shadiack, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

82082 Issued in SC

Practice address

920 Doug White Dr Ste 250
Myrtle Beach, SC 29572-4181

Phone

(843) 848-4640

Fax

(843) 839-2382

NPI assigned

Jan 5, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: Sports Medicine

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Carolina Primary Care LLCGroup PAC ID 3577629088, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grand Strand Regional Medical Center Hospital, Myrtle Beach, SC, CCN 420085

Merit-based Incentive Payment System (MIPS)

Final score

99.15 of 100Reported as individual

Promoting interoperability

99

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastal Carolina Primary Care, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Myrtle Beach, SC
  • NPI 1821257676
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Grand Strand Regional Medical Center LLC

  • General Acute Care Hospital
  • Myrlte Beach, SC
  • NPI 1083668669
  Care Compare affiliation

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1427328533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 DOUG WHITE DR STE 250",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724181",
            "telephone_number": "843-848-4640",
            "fax_number": "843-839-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 DOUG WHITE DR STE 250",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724181",
            "telephone_number": "843-848-4640",
            "fax_number": "843-839-2382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADIACK",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-05",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS13394",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "SC",
            "license": "82082",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "82082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ANTHONY.SHADIACK@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "920 Doug White Dr Ste 250",
            "city": "Myrtle Beach",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295724181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Serenity Psychiatric Solutions LLC
• Serentity Counseling & Learning Center LLC
• Allison Sexton, M.ED.
• Thany Seyok
• SH1 Happy Woods Opco LLC
• Ari Shaeffer, DO
• Austin Shaffer, DPT
• Naishaj Shah, M.D.
• Vishal Shah, DO
• Vishal Umed Shah, MD

• Family Medicine Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.