Ryan Wesley Smith, M.D.
Individual provider Active NPI Anesthesiology Physician · Myrtle Beach, SC
NPI 1861479974 · NPPES record last updated Oct 6, 2019
Key facts
- NPI
- 1861479974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 29753 (SC)
- Practice address
- 101 Surgeons Dr
Myrtle Beach, SC 29579 - Phone
- (843) 504-7194
- NPI assigned
- Dec 29, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070823000066 | SC | Practitioner - Anesthesiology | 8729051537 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beach Anesthesia, LLC | Anesthesiology | Current |
Accepting new patients |
| Ambulatory Care Anesthesia, PC | Past | Accepting new patients |
Locations
109 Blarney Dr
Columbia, SC 29223
Phone (803) 865-8200
101 Surgeons Dr
Myrtle Beach, SC 29579
Phone (803) 504-7194
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 47099 | MN | |
| Anesthesiology Physician | 207L00000X | 29753 | SC | Yes |
Addresses
Primary practice location
101 Surgeons Dr
Myrtle Beach, SC 29579
Mailing address
PO Box 1427
Columbia, SC 29202-1427
Other practice location 1
809 82nd Pkwy
Myrtle Beach, SC 29572-4607
Phone (843) 692-1062
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 777643800 | Medicaid | MN |
Other providers in Myrtle Beach, SC
- Lisa J Smith
- Michelle Reed Smith
- Morgan Lee Smith
- Robert James Smith
- Ryan Richardson Smith
- Sarah Smith
- Summer Parkman Smith
- Thomas James Smith III
- Typhani Gail Smith
- Vun Smith
All providers in Myrtle Beach, SC · Anesthesiology Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.