NPIMap

Organization Active NPI

St Paul's Medical Group, Inc

Doing business as St Pauls Medical Group

  • Clinic/Center
  • Hollywood, SC
National Provider Identifier
1740402130
Registry record updated Dec 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ST PAUL'S MEDICAL GROUP, INC
Doing business as
St Pauls Medical Group
Practice address
7610 Highway 164
Hollywood, SC 29449
Phone
(843) 889-8018
Fax
(843) 889-9133
NPI assigned
May 3, 2007
Last updated
Dec 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2009

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

Authorized official

Name
Marsha Gay Delavan, PA-CNPI 1275597742
Title
President
Phone
(843) 889-8018

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

7610 Highway 164
Hollywood, SC 29449

Mailing address

PO Box 1355
Hollywood, SC 29449-1355
Phone (843) 889-8018

Other identifiers 2

IdentifierTypeStateIssuer
GP2603MedicaidSC
42D0968299OtherSCCLIA NUMBER

Other names 1

  • ST PAULS MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory

Locations

7610 Highway 164
Hollywood, SC 29449
Phone (843) 889-8018

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1898/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1740402130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1355",
            "city": "HOLLYWOOD",
            "state": "SC",
            "postal_code": "294491355",
            "telephone_number": "843-889-8018",
            "fax_number": "843-889-9133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7610 HIGHWAY 164",
            "city": "HOLLYWOOD",
            "state": "SC",
            "postal_code": "29449",
            "telephone_number": "843-889-8018",
            "fax_number": "843-889-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PAUL'S MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "DELAVAN",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_middle_name": "GAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-889-8018",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2603",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "42D0968299",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST PAULS MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; 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.