Southern Shores Urogynecology and Pelvic Reconstructive Surgery PC

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X

Legal business name

SOUTHERN SHORES UROGYNECOLOGY AND PELVIC RECONSTRUCTIVE SURGERY PC

Practice address

1021 Cipriana Dr Ste 250
Myrtle Beach, SC 29572-4621

Phone

(843) 895-2120

NPI assigned

Jan 25, 2023

Last updated

Jan 25, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Janet E Harris-Hicks, MDNPI 1225125669

Title

Owner

Phone

(843) 895-2120

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

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.

• Janet E Harris-Hicks, M.D.

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Myrtle Beach, SC
  • NPI 1225125669
  Medicare reassignment Care Compare group NPD Authorized official
• Angela Kathline Naples, APRN FNP-C

  • Nurse Practitioner
  • Myrtle Beach, SC
  • NPI 1003494154
  Medicare reassignment Care Compare group NPD
• Jillian Abigail Benton, FNP-BC

  • Nurse Practitioner
  • Myrtle Beach, SC
  • NPI 1619772233
  Medicare reassignment NPD
• Tylan Milan Dudek, FNP-C

  • Family Nurse Practitioner
  • Aberdeen, NC
  • NPI 1154176766

  SC, Single Specialty

  Medicare reassignment NPD
• Samantha Brown

  • Physician Assistant
  • Myrtle Beach, SC
  • NPI 1104665140
  Medicare reassignment

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1669188538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 CIPRIANA DR STE 250",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 CIPRIANA DR STE 250",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724621",
            "telephone_number": "843-895-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SHORES UROGYNECOLOGY AND PELVIC RECONSTRUCTIVE SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "HARRIS-HICKS",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-895-2120",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeastern Hospitalist Services PC
• Southern Cross Psychiatric Services of South Carolina, Inc.
• Southern Home Care Services, Inc.
• Southern Myrtle Inpatient Services, LLC
• Southern Oak Dental, LLC
• Victoria Nicole Spaar, OTR
• Sparkle Dental Center Inc.
• Specialty Eye Care of the Carolinas, PC
• Specialty Pharmacy Myrtle Beach LLC (Specialty Pharmacy Myrtle Beach)
• Specialty Physical Therapy, LLC

• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.