Dewey Todd Detar, DO
Individual provider Active NPI Family Medicine Physician · Summerville, SC
NPI 1750499604 · NPPES record last updated Jun 9, 2021
Key facts
- NPI
- 1750499604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2020-00089 (NC)
- Practice address
- 1595 Central Ave
Summerville, SC 29483-5529 - Phone
- (843) 212-8080
- Fax
- (843) 789-1521
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 18
Owned or controlled facilities with NPI records 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Philadelphia College of Osteopathic Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Physicians Eldercare PA
Curana Health of North Carolina PLLC
Geriatric Consultants PLLC
Practice addresses (Care Compare)
5306 NC Hwy 55
Suite 105
Durham, NC 27713-7812
Phone (337) 991-9276
581 NC Hwy 16 S
Taylorsville, NC 28681-9103
Phone (860) 882-7525
Hospital & facility affiliations
- Four Seasons the Care You Trust
- Amorem
- Continuum Home Care & Hospice
- Hospice of the Carolina Foothills
- Blue Ridge Healthcare Hospitals, Inc
- Haywood Regional Medical Center
- Harris Regional Hospital
- Angel Medical Center
- Macon Valley Nursing and Rehabilitation Center
- Smoky Mountain Health and Rehabilitation Center
- Vero Health & Rehab of Sylva
- Magnolia Lane Nursing and Rehabilitation Center
- Highland Farms
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Smoky Mountain Health and Rehabilitation Center |
Skilled nursing facility | Managing Control - Governing Body Adp of the SNF |
Jan 5, 2023 Jun 13, 2025 |
| Magnolia Lane Nursing and Rehabilitation Center |
Skilled nursing facility | Adp of the SNF | Apr 1, 2024 |
| Macon Valley Nursing and Rehabilitation Center |
Skilled nursing facility | Managing Control - Governing Body Adp of the SNF |
Apr 1, 2024 Apr 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050714000224 | SC | Practitioner - Family Practice |
6305872029 | Reassigns benefits to 3 organizations |
| I20200603002456 | NC | Practitioner - Family Practice | 6305872029 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020-00089 | NC | MD | Family Medicine Physician |
| 483 | SC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Curana Health of North Carolina PLLC | Current |
Accepting new patients | |
| Cherokee Medical Center | Family Medicine | Current |
Accepting new patients |
| Careconnectmd North Carolina P.C. | Current |
Accepting new patients | |
| Cherokee Medical Center | Current |
Accepting new patients | |
| Spartanburg Medical Center | Family Medicine | Current |
Accepting new patients |
| Spartanburg Medical Center | Current | Accepting new patients | |
| Physicians Eldercare PA | Current |
Accepting new patients | |
| Spartanburg Medical Center | Family Medicine | Current | Accepting new patients |
| Spartanburg Medical Center | Family Medicine | Current |
Accepting new patients |
| Liberty Healthcare Group, LLC | Past | Accepting new patients | |
| Granite Falls LTC, LLC | Past | Accepting new patients | |
| Granite Falls LTC, LLC | Past | Accepting new patients | |
| Fletcher Operator LLC | Past | Accepting new patients | |
| Vero Health X, LLC | Past | Accepting new patients | |
| Snowshoe LTC Group, LLC | Past | Accepting new patients |
Locations
3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182
555 S Mangum St
Ste 100
Durham, NC 27701
Phone (323) 545-3659
5306 NC Highway 55
Ste 105
Durham, NC 27713
Phone (919) 457-1517
281 E Main St
Forest City, NC 28043
Phone (828) 245-6400
4692 Brownsboro Rd
Winston Salem, NC 27106
Phone (336) 251-1114
840 W Floyd Baker Blvd
Gaffney, SC 29341
Phone (864) 489-3300
1200 E Main St
Ste 12
Spartanburg, SC 29307
Phone (864) 560-9260
101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554
151 Peachwood Centre Dr
Spartanburg, SC 29301
Phone (864) 560-9627
2995 Reidville Rd
Ste 100
Spartanburg, SC 29301
Phone (864) 587-3000
511 Cross Anchor Rd
Woodruff, SC 29388
Phone (864) 278-6031
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2020-00089 | NC | Yes |
| Family Medicine Physician | 207Q00000X | 483 | SC |
Addresses
Primary practice location
1595 Central Ave
Summerville, SC 29483-5529
Mailing address
PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304
Other practice location 1
444 NC Hwy 108
Rutherfordton, NC 28139-7871
Phone (828) 286-2302
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004836 | Medicaid | SC | |
| SC14336067 | Other | SC | MEDICARE PIN |
| SC14336084 | Other | SC | MEDICARE PIN |
| SC1433J577 | Other | SC | MEDICARE PIN |
Other providers in Summerville, SC
- Dentistry for Children of South Carolina, PC
- Derrington Dermatology, PA
- Derrington Dermatology, PA
- Sarah M. Derrington
- Julianna Desumma
- Dawn Marie Cameron Devaux
- Brae Dewalt
- Dialysis Clinic Inc
- Kristina M Dibartolo
- Julianne Dicicco-Wiles
All providers in Summerville, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.