NPIMap

Organization Active NPI

Conway Hospital, Inc.

Doing business as CMC Pediatrics Conway

  • Pediatrics Physician
  • Conway, SC
National Provider Identifier
1558835355
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CONWAY HOSPITAL, INC.
Doing business as
CMC Pediatrics Conway
Practice address
124 Professional Park Drive, Ste a
Conway, SC 29526-9260
Phone
(843) 234-8788
Fax
(843) 234-8787
NPI assigned
Jan 15, 2019
Last updated
Jul 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Authorized official

Name
Mary Ellen Artioli
Title
Credentialing Specialist
Phone
(843) 234-6946

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Pediatric Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0200X

Addresses

Primary practice location

124 Professional Park Drive, Ste a
Conway, SC 29526-9260

Mailing address

300 Singleton Ridge Rd
Attn: Patient Accounting
Conway, SC 29526-9142
Phone (843) 234-6946

Other names 2

  • CMC Pediatrics Conway Doing business as
  • CONWAY HOSPITAL COMMUNITY SERVICES Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031201000111 SC Part B Supplier - Clinic/Group Practice 7113839606 Receives reassigned benefits from 148 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conway, SC; Surfside Beach, SC; Myrtle Beach, SC; Murrells Inlet, SC; Little River, SC; Florence, SC

Other NPIs on the same Medicare enrollment 40

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

View all 40

National Provider Directory

National Provider Directory
Tax ID family
Conway Hospital Inc CRN41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

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

View all 40

Locations

2367B Cypress Cir
Conway, SC 29526
Phone (843) 349-1001

2701 Church St
Ste F
Conway, SC 29526
Phone (843) 369-0024

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1558835355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "address_2": "ATTN: PATIENT ACCOUNTING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-234-6946",
            "fax_number": "843-234-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 PROFESSIONAL PARK DRIVE, STE A",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269260",
            "telephone_number": "843-234-8788",
            "fax_number": "843-234-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-15",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "ARTIOLI",
        "authorized_official_first_name": "MARY ELLEN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "843-234-6946"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CMC Pediatrics Conway",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CONWAY HOSPITAL COMMUNITY SERVICES",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "CONWAY HOSPITAL COMMUNITY SERVICES",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Conway, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.