NPIMap

Individual provider Active NPI

John E Rathbun, M.D.

  • Internal Medicine Physician
  • Surfside Beach, SC
National Provider Identifier
1558345686
Registry record updated Nov 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
15450 Issued in SC
Practice address
997 Highway 17 South
# C
Surfside Beach, SC 29575-6084
Phone
(843) 839-4505
Fax
(843) 839-2851
NPI assigned
Dec 1, 2005
Last updated
Nov 15, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 15450 SC Primary

Addresses

Primary practice location

997 Highway 17 South
# C
Surfside Beach, SC 29575-6084

Mailing address

997 Highway 17 South
# C
Surfside Beach, SC 29575-6084
Phone (843) 839-4505

Other identifiers 1

IdentifierTypeStateIssuer
GP0772MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120216000355 SC Practitioner - Internal Medicine 3779518121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

997 Hwy 17 S
Surfside Beach, SC 29575-6050
Phone (843) 839-4505

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
24.72 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
82.42

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15450SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Executive Court Medical Specialist P.C. CurrentSince Aug 1, 1996 Accepting new patients
Executive Court Medical Associates Inc. Past Accepting new patients

Locations

997 Highway 17 S
#C
Surfside Beach, SC 29575
Phone (843) 839-4505

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384473600000",
    "number": "1558345686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "997 HIGHWAY 17 SOUTH",
            "address_2": "# C",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295756084",
            "telephone_number": "843-839-4505",
            "fax_number": "843-839-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "997 HIGHWAY 17 SOUTH",
            "address_2": "# C",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295756084",
            "telephone_number": "843-839-4505",
            "fax_number": "843-839-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATHBUN",
        "first_name": "JOHN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2013-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "15450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0772",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Surfside Beach, SC

Sources for this page

Verify at the official NPI Registry.