Individual provider Active NPI

Cheryl Lori Zeidman, PA-C

  • Dermatology Physician
  • Myrtle Beach, SC
National Provider Identifier
1720275266
Registry record updated Apr 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
3887 Issued in SC
Practice address
5046 Highway 17 Byp S Ste 200
Myrtle Beach, SC 29588-4503
Phone
(843) 449-0453
Fax
(843) 449-9531
NPI assigned
Sep 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 3887 SC Primary

Addresses

Primary practice location

5046 Highway 17 Byp S Ste 200
Myrtle Beach, SC 29588-4503

Mailing address

1775 Timmons St
Mt Pleasant, SC 29466-7598
Phone (954) 214-8960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210312002143 SC Practitioner - Physician Assistant 1052480084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Waccamaw Dermatology LLCGroup PAC ID 7315021169, 26 clinicians

Practice addresses (Care Compare)

5500 Front St
Suite 210
Summerville, SC 29486-8140
Phone (843) 449-0453

917 Medical Cir
Myrtle Beach, SC 29572-4116
Phone (843) 449-0453

Merit-based Incentive Payment System (MIPS)

Final score
90.01 of 100Reported as group
Quality
100
Improvement activities
40
Cost
66.69

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3887SCMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Kidney Center PA PastSince Jul 1, 2017 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: czeidman@waccamawdermatology.emadirect.md

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714262400000",
    "number": "1720275266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 TIMMONS ST",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294667598",
            "telephone_number": "954-214-8960",
            "fax_number": "843-449-9531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5046 HIGHWAY 17 BYP S STE 200",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295884503",
            "telephone_number": "843-449-0453",
            "fax_number": "843-449-9531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEIDMAN",
        "first_name": "CHERYL",
        "middle_name": "LORI",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-28",
        "last_updated": "2024-04-28",
        "certification_date": "2024-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SC",
            "license": "3887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.