NPIMap

Organization Active NPI

Bay Microsurgical Unit

  • Ambulatory Surgical Clinic/Center
  • Georgetown, SC
National Provider Identifier
1487765897
Registry record updated Oct 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
ASF090 Issued in SC
Legal business name
BAY MICROSURGICAL UNIT
Practice address
1200 Highmarket St
Ste 100
Georgetown, SC 29440-3227
Phone
(843) 546-8421
Fax
(843) 546-1173
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2007

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

Authorized official

Name
Gerald E Tiller, M.D.
Title
Owner
Phone
(843) 546-8421

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X ASF090 SC Primary

Addresses

Primary practice location

1200 Highmarket St
Ste 100
Georgetown, SC 29440-3227

Mailing address

PO Box 2900
Georgetown, SC 29442-2900
Phone (843) 546-8421

Other identifiers 1

IdentifierTypeStateIssuer
410059MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041130000472 SC Part B Supplier - Ambulatory Surgical Center 9638134828 Practice locations: Georgetown, SC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Bay Microsurgical UnitCCN 42C0001005
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Bay Microsurgical Unit4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1200 Highmarket St
Georgetown, SC 29440
Phone (843) 546-8421

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1487765897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2900",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294422900",
            "telephone_number": "843-546-8421",
            "fax_number": "843-546-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HIGHMARKET ST",
            "address_2": "STE 100",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294403227",
            "telephone_number": "843-546-8421",
            "fax_number": "843-546-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY MICROSURGICAL UNIT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "TILLER",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-546-8421",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SC",
            "license": "ASF090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410059",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.