Individual provider Active NPI

John M Davis, MD

  • Specialist
  • Myrtle Beach, SC
National Provider Identifier
1649245358
Registry record updated Jun 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
38560 Issued in SC
Practice address
849 82ND Pkwy
Myrtle Beach, SC 29572-4614
Phone
(843) 497-6348
Fax
(843) 497-6351
NPI assigned
Feb 17, 2006
Last updated
Jun 10, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 25MA06665400 NJ
Specialist 174400000X 38560 SC Primary

Addresses

Primary practice location

849 82ND Pkwy
Myrtle Beach, SC 29572-4614

Mailing address

849 82ND Pkwy
Myrtle Beach, SC 29572-4614
Phone (843) 497-6348

Other identifiers 1

IdentifierTypeStateIssuer
038560200MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040526001214 NJ Practitioner - General Surgery 3274514153 Reassigns benefits to 2 organizations
I20210624002447 NY Practitioner - General Surgery 3274514153 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38560SCMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC CurrentSince Mar 23, 2021 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Dec 1, 2018 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Dec 1, 2018 Accepting new patients
Palisades Medical Associates LLC CurrentSince Jul 16, 2018 Accepting new patients
North Shore - Lij Medical PC CurrentSince Mar 23, 2021 Accepting new patients
Meridian Medical Group-Retail Clinic PC Surgery Past Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC PastSince Oct 23, 2022 Accepting new patients

Locations

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

1 Marine Plz
Ste 206
North Bergen, NJ 07047
Phone (201) 710-2772

7600 River Rd
North Bergen, NJ 07047
Phone (201) 854-5000

1945 State Route 33
Wall Township, NJ 07753
Phone (732) 776-2333

301 Montauk Hwy
Bay Shore, NY 11706
Phone (631) 630-3977

300 Community Dr
Manhasset, NY 11030

972 Brush Hollow Rd
Westbury, NY 11590

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD
  • Direct secure messaging: johndavis@nslijmedgr.allscriptsdirect.net

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465516800000",
    "number": "1649245358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "849 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724614",
            "telephone_number": "843-497-6348",
            "fax_number": "843-497-6351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "849 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724614",
            "telephone_number": "843-497-6348",
            "fax_number": "843-497-6351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA06665400",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "38560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038560200",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.