NPIMap

Individual provider Active NPI

Mohamed Mohamed Kelli, D.O

  • Surgery Physician
  • Myrtle Beach, SC
National Provider Identifier
1881089852
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
87684 Issued in SC
Practice address
920 Doug White Dr Ste 210
Myrtle Beach, SC 29572-4181
Phone
(843) 497-6348
Fax
(843) 497-6351
NPI assigned
Apr 6, 2015
Last updated
Apr 14, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Surgery Physician 208600000X 87684 SC Primary
Surgical Critical Care Physician 2086S0102X 87684 SC
Surgical Critical Care Physician 2086S0102X 5101026254 MI

Addresses

Primary practice location

920 Doug White Dr Ste 210
Myrtle Beach, SC 29572-4181

Mailing address

920 Doug White Dr Ste 210
Myrtle Beach, SC 29572-4181
Phone (843) 497-6348

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
I20220926003747 SC Practitioner - General Surgery 1557763497 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Strand Surgical Specialists LLCGroup PAC ID 4082770656, 57 clinicians

Practice addresses (Care Compare)

920 Doug White Dr
Suite 210
Myrtle Beach, SC 29572-4181
Phone (843) 497-6348

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue17

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Strand Surgical Specialists, LLC Surgery CurrentSince Sep 19, 2022 Accepting new patients
Grand Strand Regional Medical Center LLC Past Accepting new patients

Locations

4237 River Hills Dr
Ste 150
Little River, SC 29566
Phone (843) 281-2778

920 Doug White Dr
Ste 210
Myrtle Beach, SC 29572
Phone (843) 497-6348

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Interoperability endpoints

  • Direct secure messaging: mohamed.mohamedkelli@hca5.eclinicaldirectplus.com

Organizations & group practices 2

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": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1881089852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 DOUG WHITE DR STE 210",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724181",
            "telephone_number": "843-497-6348",
            "fax_number": "843-497-6351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 DOUG WHITE DR STE 210",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724181",
            "telephone_number": "843-497-6348",
            "fax_number": "843-497-6351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMED KELLI",
        "first_name": "MOHAMED",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-06",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "87684",
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "SC",
            "license": "87684",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MI",
            "license": "5101026254",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.