Individual provider Active NPI

Alexandra L Edenfield, PA

  • Physician Assistant
  • Port Royal, SC
National Provider Identifier
1669892626
Registry record updated Jun 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2099 Issued in SC
Practice address
2210 Mossy Oaks Rd
Port Royal, SC 29935-1046
Phone
(843) 986-0900
NPI assigned
Apr 17, 2014
Last updated
Jun 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2099 SC Primary

Addresses

Primary practice location

2210 Mossy Oaks Rd
Port Royal, SC 29935-1046

Mailing address

721 Okatie Hwy
Okatie, SC 29909-3963
Phone (843) 987-7400

Other practice location 1

109 S. Green Street
Ridgeland, SC 29936
Phone (843) 726-6773

Other practice location 2

218 E Blackstock Rd
Spartanburg, SC 29301-2607
Phone (864) 576-8646

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140619001314 SC Practitioner - Physician Assistant 6204050974 Reassigns benefits to 2 organizations
I20151002002490 NC Practitioner - Physician Assistant 6204050974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cora South Carolina LLCGroup PAC ID 3173766334, shared by 6 NPIs, 220 clinicians

Practice addresses (Care Compare)

18 Professional Village Cir
Beaufort, SC 29907-1570
Phone (843) 986-9670

721 N Okatie Hwy
Ridgeland, SC 29936-8276

721 Okatie Hwy
Okatie, SC 29909-3963
Phone (843) 987-7400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2099SCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Gastonia Physician Services, PLLC CurrentSince Jul 11, 2015 Accepting new patients
Beaufort Jasper Hampton Comprehensive Health Services, Inc CurrentSince Sep 1, 2022 Accepting new patients
Tricia Etheridge, MD, PC CurrentSince Dec 5, 2021 Accepting new patients
Beaufort Jasper Hampton Comprehensive Health Services, Inc. CurrentSince Sep 1, 2022 Accepting new patients
Saint Josephs Medical Group Inc Past Accepting new patients
Beaufort-Jasper-Hampton Comprehensive Health Service Inc Past Accepting new patients

Locations

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

721 Okatie Hwy
Okatie, SC 29909

109 S Green St
Ridgeland, SC 29936
Phone (843) 726-6773

721 N Okatie Hwy
Ridgeland, SC 29936
Phone (843) 987-7492

721 N Okatie Hwy
#170
Ridgeland, SC 29936

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/EGDCBD
  • FHIR API: https://fhir4.healow.com/fhir/r4/EICIBD

Organizations & group practices 8

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1669892626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 OKATIE HWY",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-987-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 MOSSY OAKS RD",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299351046",
            "telephone_number": "843-986-0900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 S. Green Street",
            "address_purpose": "LOCATION",
            "city": "Ridgeland",
            "state": "SC",
            "postal_code": "29936",
            "country_code": "US",
            "telephone_number": "843-726-6773",
            "fax_number": "843-726-6778",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "218 E Blackstock Rd",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293012607",
            "country_code": "US",
            "telephone_number": "864-576-8646",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDENFIELD",
        "first_name": "ALEXANDRA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-17",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Royal, SC

Sources for this page

Verify at the official NPI Registry.