NPIMap

Organization Active NPI

Beaufort County Memorial Hospital

  • Psychiatric Hospital Unit
  • Beaufort, SC
National Provider Identifier
1629068531
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Practice address
955 Ribaut Rd
Beaufort, SC 29902-5441
Phone
(843) 522-5200
Fax
(843) 522-5975
NPI assigned
Oct 24, 2005
Last updated
Mar 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Authorized official

Name
Mr. Edmond Russell Baxley III
Title
Ceo
Phone
(843) 522-5140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X SC Primary

Addresses

Primary practice location

955 Ribaut Rd
Beaufort, SC 29902-5441

Mailing address

955 Ribaut Rd
Beaufort, SC 29902-5441
Phone (843) 522-5200

Other identifiers 1

IdentifierTypeStateIssuer
10767AMedicaidSC

Other names 1

  • BMH Inpatient Psychiatric Unit Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160511001562 SC Part A Provider - Hospital 7810809365 Practice locations: Beaufort, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629068531. Details of each certification follow.

Hospital certification: CCN 42S067

Legal name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Doing business as
BMH INPATIENT PSYCHIATRIC UNTI
Organization structure
OtherNon-profit
Enrollment address
955 Ribaut Rd
Beaufort, SC 29902-5441
Other Hospital Practice Location
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christopher Michael Ketchie Individual Corporate Officer Sep 12, 2016
Edmond Baxley Individual Corporate Officer Sep 16, 2016
Trimmell Simmons Individual W-2 Managing Employee Dec 18, 2011

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Beaufort County Memorial HospitalBeaufort, SC, CCN 420067 Hospital Operational/Managerial Control Apr 3, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1629068531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 RIBAUT RD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "telephone_number": "843-522-5200",
            "fax_number": "843-522-5975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 RIBAUT RD",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025441",
            "telephone_number": "843-522-5200",
            "fax_number": "843-522-5975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUFORT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "BAXLEY",
        "authorized_official_first_name": "EDMOND",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-522-5140",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10767A",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMH Inpatient Psychiatric Unit",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "BMH Inpatient Psychiatric Unit",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaufort, SC

Sources for this page

Verify at the official NPI Registry.