Individual provider Active NPI

Michael A Beasley, DO

  • Emergency Medicine Physician
  • Georgetown, SC
National Provider Identifier
1477554830
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
T6002 Issued in SC
Practice address
606 Black River Rd
Georgetown, SC 29440-3304
Phone
(843) 527-7000
NPI assigned
Aug 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X T6002 SC Primary

Addresses

Primary practice location

606 Black River Rd
Georgetown, SC 29440-3304

Mailing address

PO Box 1718
Georgetown, SC 29442-1718

Other identifiers 1

IdentifierTypeStateIssuer
006923MedicaidSC

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20050421000371 NC Practitioner - Emergency Medicine 4183662000 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

500 S Academy St
Vidant Roanoke Chowan Hospital
Ahoskie, NC 27910-3261
Phone (252) 209-3360

Hospital & facility affiliations

  • Vidant Roanoke Chowan Hospital Hospital, Ahoskie, NC, CCN 340099

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
T6002SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Apr 11, 2024 Accepting new patients

Locations

500 Academy St S
Ahoskie, NC 27910
Phone (252) 209-3000

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1477554830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1718",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294421718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 BLACK RIVER RD",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294403304",
            "telephone_number": "843-527-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEASLEY",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "T6002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006923",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, SC

Sources for this page

Verify at the official NPI Registry.