NPIMap

Individual provider Active NPI

Madison Blaire Kent

  • Family Nurse Practitioner
  • Loris, SC
National Provider Identifier
1629849302
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
28278 Issued in SC
Practice address
4520 Broad St
Loris, SC 29569-2422
Phone
(843) 756-0959
NPI assigned
Jan 11, 2024
Last updated
Jan 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 28278 SC Primary

Addresses

Primary practice location

4520 Broad St
Loris, SC 29569-2422

Mailing address

4206 Seaview St Apt 2
North Myrtle Beach, SC 29582-5142
Phone (864) 430-9948

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
I20240325001737 SC Practitioner - Nurse Practitioner 2860839909 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lowcountry Urgent Care LLCGroup PAC ID 9739210337, 81 clinicians
Conway Hospital Emergency Professional ServicesGroup PAC ID 2163516980, 20 clinicians

Practice addresses (Care Compare)

182 C Sea Island Pkwy
Beaufort, SC 29907-1503
Phone (843) 322-1933

300 Singleton Ridge Rd
Conway, SC 29526-9142
Phone (843) 347-7111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lowcountry Urgent Care LLC CurrentSince Jan 10, 2024 Accepting new patients
Conway Hospital Emergency Professional Services CurrentSince May 1, 2026 Accepting new patients

Locations

182C Sea Island Pkwy
Beaufort, SC 29907
Phone (843) 322-1933

300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946

4520 Broad St
Loris, SC 29569
Phone (803) 272-0702

1515 Bells Hwy
Walterboro, SC 29488
Phone (843) 522-8223

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1629849302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4206 SEAVIEW ST APT 2",
            "city": "NORTH MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295825142",
            "telephone_number": "864-430-9948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 BROAD ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692422",
            "telephone_number": "843-756-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENT",
        "first_name": "MADISON",
        "middle_name": "BLAIRE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "28278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loris, SC

Sources for this page

Verify at the official NPI Registry.