NPIMap

Organization Active NPI

Beaufort County Memorial Hosptial

  • Specialist
  • Beaufort, SC
National Provider Identifier
1720212129
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
BEAUFORT COUNTY MEMORIAL HOSPTIAL
Practice address
989 Ribaut Rd
Suite 220
Beaufort, SC 29902-5472
Phone
(843) 522-5742
NPI assigned
May 13, 2009
Last updated
Mar 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Authorized official

Name
Edmond Russell Baxley III
Title
Ceo
Phone
(843) 522-5140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

989 Ribaut Rd
Suite 220
Beaufort, SC 29902-5472

Mailing address

1055 Ribaut Rd
Suite 30
Beaufort, SC 29902-5423
Phone (843) 522-5742

Other names 1

  • BEAUFORT MEMORIAL SURGICAL SPECIALISTS WCC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050518001061 SC Part B Supplier - Clinic/Group Practice 7810809365 Receives reassigned benefits from 141 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Varnville, SC; Port Royal, SC; Okatie, SC; Bluffton, SC; Beaufort, SC

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1720212129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 RIBAUT RD",
            "address_2": "SUITE 30",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025423",
            "telephone_number": "843-522-5742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "989 RIBAUT RD",
            "address_2": "SUITE 220",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025472",
            "telephone_number": "843-522-5742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUFORT COUNTY MEMORIAL HOSPTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-13",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "BAXLEY",
        "authorized_official_first_name": "EDMOND",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-522-5140",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEAUFORT MEMORIAL SURGICAL SPECIALISTS WCC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaufort, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.