NPIMap

Organization Active NPI

Georgetown Physician Associates, LLC

Doing business as Tidelands Health Family Medicine

  • Rural Health Clinic/Center
  • Georgetown, SC
National Provider Identifier
1841364007
Registry record updated May 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Doing business as
Tidelands Health Family Medicine
Practice address
1075 N Fraser St
Georgetown, SC 29440-2848
Phone
(843) 527-4442
Fax
(843) 527-4027
NPI assigned
Nov 20, 2006
Last updated
May 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2020

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

Authorized official

Name
Elizabeth Ward
Title
Evp & Cfo
Phone
(843) 527-7102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1075 N Fraser St
Georgetown, SC 29440-2848

Mailing address

PO Box 421718
Georgetown, SC 29442-4203
Phone (843) 520-8883

Other identifiers 1

IdentifierTypeStateIssuer
RHC132MedicaidSC

Other names 1

  • Tidelands Health Family Medicine Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@tidelandshealth.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141021000426 SC Part A Provider - Rural Health Clinic 2365697398 Practice locations: Georgetown, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841364007. Details of each certification follow.

Rural health clinic certification: CCN 428958

Legal name
GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Doing business as
TIDELANDS HEALTH FAMILY MEDICINE AT GEORGETOWN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 23, 2003
Last certification
Nov 10, 2021
Ownership / control type
1B
Most recent change of ownership
Oct 1, 2014 (1 total)
Organization structure
LLCNon-profit
Incorporated
Nov 7, 2012 in SC
Enrollment address
1075 N Fraser St
Georgetown, SC 29440-2848

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Georgetown Physician Associates LLC16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Georgetown Hospital System Organization, Georgetown, SC Corporation, Non-profit, Chain home office Operational/Managerial Control Oct 1, 2020
Medical University Hospital Authority Organization, Charleston, SC Corporation, Holding company, Non-profit Operational/Managerial Control Oct 1, 2020
Bruce Bailey Individual Corporate OfficerEvp&Ceo Mar 29, 2002
W-2 Managing EmployeeEvp&Ceo Mar 29, 2002
Operational/Managerial ControlEvp&Ceo Mar 29, 2002
Francis Ford Individual Corporate DirectorMember of Board of Directors Oct 23, 2008
Operational/Managerial ControlMember of Board of Directors Oct 23, 2008
Matthew Severence Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Gayle Resetar Individual Corporate OfficerEvp&Coo Mar 29, 2002
W-2 Managing EmployeeEvp&Coo Mar 29, 2002
Operational/Managerial ControlEvp&Coo Mar 29, 2002
Georgetown Physician Services, LLC Organization, Georgetown, SC Corporation, LLC, Non-profit 5% Or Greater Direct Ownership Interest Nov 7, 2012 100%
Saju D Joy Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Daniel Scheffing Individual Corporate DirectorMember of Board of Directors Feb 17, 2011
Operational/Managerial ControlMember of Board of Directors Feb 17, 2011
Tidelands Health Holdings Organization, Georgetown, SC Corporation, Holding company, Non-profit Operational/Managerial Control Oct 1, 2020
Paul Davis Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Patrick J Cawley Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Erin Beadle Individual Corporate OfficerEvp&Cfo Jan 7, 2025
W-2 Managing EmployeeEvp&Cfo Jan 7, 2025
Operational/Managerial ControlEvp&Cfo Jan 7, 2025
Philip M Dulberger Individual Corporate OfficerEvp & Chief Physician Executive Sep 9, 2013
W-2 Managing EmployeeEvp & Chief Physician Executive Sep 9, 2013
Operational/Managerial ControlEvp & Chief Physician Executive Sep 9, 2013
James Battle Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Eugene S Hong Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Charles Schulze Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Richard M Christian Individual Corporate DirectorMember of Board of Directors Oct 1, 2025
Operational/Managerial ControlMember of Board of Directors Oct 1, 2025
Derek Dudley Individual Corporate DirectorVP Revenue Cycle May 31, 2024
W-2 Managing EmployeeVP Revenue Cycle May 31, 2024
Operational/Managerial ControlVP Revenue Cycle May 31, 2024
Ashley Chisolm Individual W-2 Managing EmployeeReimbursement Director Oct 1, 2025

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Georgetown Memorial Hospital

    dba Tidelands Health Skilled Care

    • Skilled Nursing Facility
    • Georgetown, SC
    • NPI 1881307056

    Georgetown Hospital System, Medical University Hospital Authority, Tidelands Health Holdings

    CMS ownership
  • Georgetown Memorial Hospital

    dba Tidelands Georgetown Memorial Hospital

    • General Acute Care Hospital
    • Georgetown, SC
    • NPI 1982604021

    Georgetown Hospital System, Medical University Hospital Authority, Tidelands Health Holdings

    CMS ownership
  • Georgetown Physician Associates, LLC

    dba Tidelands Health Family Medicine

    • Rural Health Clinic/Center
    • Andrews, SC
    • NPI 1104995372

    Georgetown Hospital System, Georgetown Physician Services, LLC, Medical University Hospital Authority, Tidelands Health Holdings

    CMS ownership
  • Georgetown Physician Associates, LLC

    dba Tidelands Health Family Medicine

    • Rural Health Clinic/Center
    • Pawley's Island, SC
    • NPI 1306028832

    Georgetown Hospital System, Georgetown Physician Services, LLC, Medical University Hospital Authority, Tidelands Health Holdings

    CMS ownership
  • Georgetown Physician Associates, LLC

    dba Tidelands Health Family Medicine

    • Rural Health Clinic/Center
    • Hemingway, SC
    • NPI 1588716815

    Georgetown Hospital System, Georgetown Physician Services, LLC, Medical University Hospital Authority, Tidelands Health Holdings

    CMS ownership
  • Medical University Hospital Authority

    dba MUSC Health Lancaster Rehabilitation Center

    • Rehabilitation Hospital Unit
    • Lancaster, SC
    • NPI 1144793654

    Medical University Hospital Authority

    CMS ownership
  • Medical University Hospital Authority

    dba MUSC Health Lancaster Medical Center

    • General Acute Care Hospital
    • Lancaster, SC
    • NPI 1700359205

    Medical University Hospital Authority

    CMS ownership
  • Medical University Hospital Authority

    dba MUSC Health Primary Care - Thurgood Marshall Blvd

    • Rural Health Clinic/Center
    • Kingstree, SC
    • NPI 1770219412

    Medical University Hospital Authority

    CMS ownership
  • Musc Community Physicians

    dba MUSC Health Primary Care - Branchville

    • Rural Health Clinic/Center
    • Branchville, SC
    • NPI 1043916448

    Medical University Hospital Authority

    CMS ownership
  • Waccamaw Community Hospital

    dba Tidelands Waccamaw Community Hospital

    • General Acute Care Hospital
    • Murrells Inlet, SC
    • NPI 1972503910

    Georgetown Hospital System, Medical University Hospital Authority, Tidelands Health Holdings

    CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1841364007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421718",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294424203",
            "telephone_number": "843-520-8883",
            "fax_number": "843-652-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402848",
            "telephone_number": "843-527-4442",
            "fax_number": "843-527-4027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGETOWN PHYSICIAN ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "843-527-7102"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC132",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@tidelandshealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1075 N Fraser St",
            "city": "Georgetown",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294402848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tidelands Health Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, SC

Sources for this page

Verify at the official NPI Registry.