NPIMap

Organization Active NPI

Conway Hospital Inc

Doing business as CMC Pediatrics Carolina Forest

  • Pediatrics Physician
  • Myrtle Beach, SC
National Provider Identifier
1760630966
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CONWAY HOSPITAL INC
Doing business as
CMC Pediatrics Carolina Forest
CMC Pediatrics Towne Center
Practice address
4022 Postal Way
Suite C
Myrtle Beach, SC 29579-3537
Phone
(843) 903-4111
Fax
(843) 903-4242
NPI assigned
Sep 3, 2008
Last updated
Feb 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Authorized official

Name
Mary Ellen Artioli
Title
Credentialing Specialist
Phone
(843) 234-6946

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

4022 Postal Way
Suite C
Myrtle Beach, SC 29579-3537

Mailing address

300 Singleton Ridge Rd
Attn: Patient Accounting
Conway, SC 29526-9142
Phone (843) 234-6946

Other practice location 1

5010 Carolina Forest Blvd
Myrtle Beach, SC 29579-3579
Phone (843) 236-2700

Other identifiers 1

IdentifierTypeStateIssuer
GP4505MedicaidSC

Other names 4

  • CMC PEDIATRICS CAROLINA FOREST Doing business as
  • CMC PEDIATRICS TOWNE CENTER Doing business as
  • CONWAY HOSPITAL COMMUNITY SERVICES Former legal business name
  • CPG PEDIATRICS CAROLINA FOREST Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031201000111 SC Part B Supplier - Clinic/Group Practice 7113839606 Receives reassigned benefits from 148 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conway, SC; Surfside Beach, SC; Myrtle Beach, SC; Murrells Inlet, SC; Little River, SC; Florence, SC

Other NPIs on the same Medicare enrollment 40

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

View all 40

National Provider Directory

National Provider Directory
Tax ID family
Conway Hospital Inc41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1760630966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "address_2": "ATTN: PATIENT ACCOUNTING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-234-6946",
            "fax_number": "843-234-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4022 POSTAL WAY",
            "address_2": "SUITE C",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295793537",
            "telephone_number": "843-903-4111",
            "fax_number": "843-903-4242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5010 Carolina Forest Blvd",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295793579",
            "country_code": "US",
            "telephone_number": "843-236-2700",
            "fax_number": "843-236-2726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONWAY HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-03",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "ARTIOLI",
        "authorized_official_first_name": "MARY ELLEN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "843-234-6946"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4505",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CMC PEDIATRICS CAROLINA FOREST",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CMC PEDIATRICS TOWNE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CONWAY HOSPITAL COMMUNITY SERVICES",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "CONWAY HOSPITAL COMMUNITY SERVICES",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "CPG PEDIATRICS CAROLINA FOREST",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; 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.