NPIMap

Individual provider Active NPI

Bradley Lineback, M.D.

  • Obstetrics & Gynecology Physician
  • Conway, SC
National Provider Identifier
1841390192
Registry record updated Oct 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
11902 Issued in SC
Practice address
8016 Myrtle Trace Dr
Conway, SC 29526-8945
Phone
(843) 347-7266
Fax
(843) 347-2130
NPI assigned
Sep 25, 2006
Last updated
Oct 4, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 11902 SC Primary

Addresses

Primary practice location

8016 Myrtle Trace Dr
Conway, SC 29526-8945

Mailing address

PO Box 2180
Conway, SC 29528-2180
Phone (843) 347-7266

Other identifiers 2

IdentifierTypeStateIssuer
119026MedicaidSC
GP4505MedicaidSC

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
I20111121000398 SC Practitioner - Obstetrics/Gynecology 6507048543 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of South Carolina School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Hospital IncGroup PAC ID 7113839606, 127 clinicians

Practice addresses (Care Compare)

2376 Cypress Cir
Suite 200
Conway, SC 29526-8994
Phone (843) 347-7216

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
52.78 of 100Reported as group
Quality
55.48
Improvement activities
0
Cost
74.21

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11902SCMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital, Inc. CurrentSince Dec 18, 2019 Accepting new patients
Conway Hospital, Inc. CurrentSince Dec 18, 2019 Accepting new patients
Conway Obstectrics and Gynecology Obstetrics & Gynecology Current Accepting new patients
Conway Hospital, Inc. Past Accepting new patients
Conway Hospital Long Term Care Services, Inc Past Accepting new patients

Locations

2376 Cypress Cir
Ste 200
Conway, SC 29526
Phone (843) 234-1710

2376 Cypress Cir
Ste 200A
Conway, SC 29526
Phone (843) 347-7216

300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946

394 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 347-8050

8016 Myrtle Trace Dr
Conway, SC 29526
Phone (843) 347-7266

808 Farrar Dr
Conway, SC 29526
Phone (843) 234-8700

Organizations & group practices 5

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475539200000",
    "number": "1841390192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2180",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295282180",
            "telephone_number": "843-347-7266",
            "fax_number": "843-234-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8016 MYRTLE TRACE DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268945",
            "telephone_number": "843-347-7266",
            "fax_number": "843-347-2130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINEBACK",
        "first_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2016-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "SC",
            "license": "11902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119026",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4505",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.