NPIMap

Individual provider Active NPI

Mercedes Zimmerman Davis, PA-C

  • Physician Assistant
  • Myrtle Beach, SC
National Provider Identifier
1831204676
Registry record updated Nov 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2292 Issued in SC
Practice address
106 Lansford PL
Myrtle Beach, SC 29588-6979
Phone
(843) 293-8850
Fax
(843) 293-8860
NPI assigned
Aug 20, 2006
Last updated
Nov 23, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001000495 NC
Physician Assistant 363A00000X MA054212 PA
Physician Assistant 363A00000X PA2292 SC Primary

Addresses

Primary practice location

106 Lansford PL
Myrtle Beach, SC 29588-6979

Mailing address

106 Lansford PL
Myrtle Beach, SC 29588-6979
Phone (843) 293-8850

Other names 1

  • Mercedes Anna Zimmerman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161228000334 SC Practitioner - Physician Assistant 1557464971 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
Family Medicine of Sayebrook LLCGroup PAC ID 4789685256, 5 clinicians

Practice addresses (Care Compare)

106 Lansford CT
Suite 100
Myrtle Beach, SC 29588-3501
Phone (843) 293-8850

106 Lansford PL
Suite 100
Myrtle Beach, SC 29588-6979

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001000495NCMDPhysician Assistant
PA2292SCMDPhysician Assistant

Organizations & group practices 1

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

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1831204676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 LANSFORD PL",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295886979",
            "telephone_number": "843-293-8850",
            "fax_number": "843-293-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 LANSFORD PL",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295886979",
            "telephone_number": "843-293-8850",
            "fax_number": "843-293-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MERCEDES",
        "middle_name": "ZIMMERMAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001000495",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA054212",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "PA2292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MERCEDES",
            "last_name": "ZIMMERMAN",
            "middle_name": "ANNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.