NPIMap

Organization Active NPI

Beaufort Pediatrics, P.a.

  • Pediatric Adolescent Medicine Physician
  • Beaufort, SC
National Provider Identifier
1467413641
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
BEAUFORT PEDIATRICS, P.A.
Practice address
964 Ribaut Rd
Beaufort, SC 29902-5429
Phone
(843) 524-5437
Fax
(843) 524-0425
NPI assigned
Mar 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Authorized official

Name
Dr. Joseph H Floyd, M.D.NPI 1285694976
Title
Preisdent
Phone
(843) 524-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

964 Ribaut Rd
Beaufort, SC 29902-5429

Mailing address

964 Ribaut Rd
Beaufort, SC 29902-5429
Phone (843) 524-5437

Other identifiers 1

IdentifierTypeStateIssuer
RHC156MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051214000156 SC Part A Provider - Rural Health Clinic 9830110162 Practice locations: Beaufort, SC

Rural health clinic certification: CCN 428981

Legal name
BEAUFORT PEDIATRICS PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 17, 2006
Last certification
Jan 2, 2020
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jul 31, 2000 in SC
Enrollment address
964 Ribaut Rd
Beaufort, SC 29902-5429

National Provider Directory

National Provider Directory
Tax ID family
Beaufort Pediatrics3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Kimberly Martin Individual 5% Or Greater Direct Ownership Interest Sep 1, 2021 33%
Operational/Managerial Control Sep 1, 2021
Yolanda J Dreier Individual 5% Or Greater Direct Ownership Interest Sep 1, 2021 33%
Operational/Managerial Control Sep 1, 2021
Joseph Floyd Individual Corporate Officer Aug 1, 2000 25%
W-2 Managing Employee Aug 1, 2000
Operational/Managerial Control Aug 1, 2000 25%
William Martin Individual 5% Or Greater Direct Ownership InterestMedical Director Jul 15, 2013 33%
Corporate DirectorMedical Director Sep 1, 2021 33%
W-2 Managing Employee Sep 1, 2021 33%
Operational/Managerial Control Sep 1, 2021 33%

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1467413641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "964 RIBAUT RD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025429",
            "telephone_number": "843-524-5437",
            "fax_number": "843-524-0425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 RIBAUT RD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025429",
            "telephone_number": "843-524-5437",
            "fax_number": "843-524-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUFORT PEDIATRICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "FLOYD",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PREISDENT",
        "authorized_official_telephone_number": "843-524-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC156",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaufort, SC

Sources for this page

Verify at the official NPI Registry.