NPIMap

Organization Active NPI

Georgetown Physician Associates, LLC

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Murrells Inlet, SC
National Provider Identifier
1548604366
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X
Legal business name
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Practice address
4367 Riverwood Dr Unit 104
Murrells Inlet, SC 29576-4381
Phone
(843) 652-8020
Fax
(843) 652-8021
NPI assigned
Apr 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PE0005X Primary

Addresses

Primary practice location

4367 Riverwood Dr Unit 104
Murrells Inlet, SC 29576-4381

Mailing address

PO Box 421718
Georgetown, SC 29442-4203
Phone (843) 520-8883

Other practice location 1

4033 Highway 17
Murrells Inlet, SC 29576-5032
Phone (843) 652-8020

Other identifiers 1

IdentifierTypeStateIssuer
GP6251MedicaidSC

Other names 1

  • Tidelands Health Wound Healing Center 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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2147099Tidelands Health Next Step Wound Healing4367 Riverwood Dr, Suite 140, Murrells Inlet, SC 29576Certificate of waiverApr 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
Georgetown Physician Associates16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

4367 Riverwood Dr
Unit 104
Murrells Inlet, SC 29576
Phone (843) 652-8020

Practitioners & affiliated clinicians

Practitioners 5

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": "1366675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1548604366",
    "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": "843-520-8883",
            "fax_number": "843-652-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4367 RIVERWOOD DR UNIT 104",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295764381",
            "telephone_number": "843-652-8020",
            "fax_number": "843-652-8021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4033 Highway 17",
            "address_purpose": "LOCATION",
            "city": "Murrells Inlet",
            "state": "SC",
            "postal_code": "295765032",
            "country_code": "US",
            "telephone_number": "843-652-8020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GEORGETOWN PHYSICIAN ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-23",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "SUTHERLAND",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "843-527-7102"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6251",
            "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": "4367 Riverwood Dr Unit 140",
            "city": "Murrells Inlet",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29576",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tidelands Health Wound Healing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Murrells Inlet, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; 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.