NPIMap

Organization Active NPI

Edisto Regional Health Services Inc.

  • Family Medicine Physician
  • Denmark, SC
National Provider Identifier
1598080079
Registry record updated Mar 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19072 Issued in SC
Legal business name
EDISTO REGIONAL HEALTH SERVICES INC.
Practice address
5073 Carolina Hwy
Denmark, SC 29042-1679
Phone
(803) 245-5144
Fax
(803) 245-6277
NPI assigned
Mar 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2010

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

Authorized official

Name
Ms. Lisa M Goodlett
Title
C.O.O.
Phone
(803) 395-2462

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 19072 SC Primary

Addresses

Primary practice location

5073 Carolina Hwy
Denmark, SC 29042-1679

Mailing address

PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4497

Other names 1

  • William D. Glenn IV MD Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810000307 SC Part B Supplier - Clinic/Group Practice 4981693447 Receives reassigned benefits from 41 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowman, SC; Bamberg, SC; Santee, SC; Saint Matthews, SC; Orangeburg, SC; Holly Hill, SC; Branchville, SC

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1269820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269993600000",
    "number": "1598080079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161245",
            "telephone_number": "803-395-4497",
            "fax_number": "803-536-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5073 CAROLINA HWY",
            "city": "DENMARK",
            "state": "SC",
            "postal_code": "290421679",
            "telephone_number": "803-245-5144",
            "fax_number": "803-245-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO REGIONAL HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-29",
        "last_updated": "2010-03-31",
        "status": "A",
        "authorized_official_last_name": "GOODLETT",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "803-395-2462",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "19072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "William D. Glenn IV MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denmark, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2010; 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.