NPIMap

Organization Active NPI

South Carolina Podiatric Physicians and Surgeons Group, LLC

  • Podiatrist
  • Surfside Beach, SC
National Provider Identifier
1659797157
Registry record updated Mar 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Practice address
1120 Glenns Bay Rd
Suite 103
Surfside Beach, SC 29575-4757
Phone
(843) 449-8079
Fax
(843) 497-6147
NPI assigned
Mar 9, 2014
Last updated
Mar 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2014

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

Authorized official

Name
Brandon PercivalNPI 1518930817
Title
President
Phone
(803) 285-1411

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213E00000X SC Primary
Foot & Ankle Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0103X SC
Foot Surgery PodiatristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 213ES0131X SC

Addresses

Primary practice location

1120 Glenns Bay Rd
Suite 103
Surfside Beach, SC 29575-4757

Mailing address

8141 Rourk St
Myrtle Beach, SC 29572-4128
Phone (843) 449-8079

National Provider Directory

National Provider Directory

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": "1394323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394928000000",
    "number": "1659797157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8141 ROURK ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724128",
            "telephone_number": "843-449-8079",
            "fax_number": "843-497-6147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 GLENNS BAY RD",
            "address_2": "SUITE 103",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295754757",
            "telephone_number": "843-449-8079",
            "fax_number": "843-497-6147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-09",
        "last_updated": "2014-03-16",
        "status": "A",
        "authorized_official_last_name": "PERCIVAL",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-285-1411"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Surfside Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.