NPIMap

Organization Active NPI

Georgetown Physician Associates, LLC

Doing business as Tidelands Health Family Medicine

  • Family Medicine Physician
  • Georgetown, SC
National Provider Identifier
1508849837
Registry record updated Jun 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Doing business as
Tidelands Health Family Medicine
Practice address
1075 N Fraser St
Georgetown, SC 29440-2848
Phone
(843) 546-5128
Fax
(843) 527-4027
NPI assigned
Nov 21, 2005
Last updated
Jun 15, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
TIDELANDS HEMINGWAY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

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

Authorized official

Name
Elizabeth Ward
Title
Evp & Cfo
Phone
(843) 527-7102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1075 N Fraser St
Georgetown, SC 29440-2848

Mailing address

PO Box 421718
Georgetown, SC 29442-4203
Phone (843) 520-8330

Other practice location 1

456 N Main St
Hemingway, SC 29554-9190
Phone (803) 546-5128

Other practice location 2

701 S Morgan Ave
Andrews, SC 29510-2959
Phone (843) 546-5128

Other identifiers 3

IdentifierTypeStateIssuer
GP6617 HEMINGWAYMedicaidSC
GP6558 G'TOWNMedicaidSC
GP6616 ANDREWSMedicaidSC

Other names 1

  • Tidelands Health Family Medicine Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@tidelandshealth.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130225000067 SC Part B Supplier - Clinic/Group Practice 2365697398 Receives reassigned benefits from 302 practitioners
30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Murrells Inlet, SC; Myrtle Beach, SC; Pawleys Island, SC; Andrews, SC; Georgetown, SC; Hemingway, SC

Other NPIs on the same Medicare enrollment 30

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 30

National Provider Directory

National Provider Directory
Part of
Georgetown Physician Associates LLC

Locations

1075 N Fraser St
Georgetown, SC 29440
Phone (843) 527-3588

456 N Main St
Hemingway, SC 29554
Phone (843) 558-9319

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1508849837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421718",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294424203",
            "telephone_number": "843-520-8330",
            "fax_number": "843-652-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402848",
            "telephone_number": "843-546-5128",
            "fax_number": "843-527-4027"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "456 N Main St",
            "address_purpose": "LOCATION",
            "city": "Hemingway",
            "state": "SC",
            "postal_code": "295549190",
            "country_code": "US",
            "telephone_number": "803-546-5128",
            "fax_number": "843-527-4027",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 S Morgan Ave",
            "address_purpose": "LOCATION",
            "city": "Andrews",
            "state": "SC",
            "postal_code": "295102959",
            "country_code": "US",
            "telephone_number": "843-546-5128",
            "fax_number": "843-527-4027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GEORGETOWN PHYSICIAN ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIDELANDS HEMINGWAY MEDICAL CENTER",
        "enumeration_date": "2005-11-21",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "843-527-7102"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6617 HEMINGWAY",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6558 G'TOWN",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6616 ANDREWS",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@tidelandshealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1075 N Fraser St",
            "city": "Georgetown",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294402848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tidelands Health Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.