Samai Supan, M.D.

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

11283 Issued in SC

Practice address

719 Okatie Hwy # 170
Okatie, SC 29909-3963

Phone

(843) 987-7400

Fax

(843) 987-5135

NPI assigned

Mar 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Beaufort Jasper Hampton Comprehensive Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ridgeland, SC
  • NPI 1649276148
  Medicare reassignment

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1861451569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 SPANISH POINT DR",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299026126",
            "telephone_number": "843-525-6569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 OKATIE HWY # 170",
            "city": "OKATIE",
            "state": "SC",
            "postal_code": "299093963",
            "telephone_number": "843-987-7400",
            "fax_number": "843-987-5135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPAN",
        "first_name": "SAMAI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "SC",
            "license": "11283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "11283",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Carolina Health Services
• South Carolina Health Services, Inc.
• Richard Spector, PT,DPT
• Sprenger Healthcare of Bluffton, Inc
• Strength in Your Story Counseling Services, PC
• Jennifer Talley, RN
• Bobbi J Tenwolde, MD
• Annette Nimmer Thomas, MD
• Ashley Tinney
• Jessica Nicole Trani, PTA

• Adult Medicine Physician in Okatie, SC
• Providers in Okatie, SC by specialty
• Adult Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.