Taylor Keith Baucom, PA-C
Individual provider Active NPI Physician Assistant · Little River, SC
NPI 1891479929 · NPPES record last updated Jun 9, 2023
Key facts
- NPI
- 1891479929
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 4861 (SC)
- Practice address
- 3793 McDowell LN
Medical Park 2, Suite 100
Little River, SC 29566 - Phone
- (843) 390-0100
- NPI assigned
- Jun 9, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Medical University of South Carolina College of Medicine, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- McLeod Physician Associates II
Practice addresses (Care Compare)
101 McLeod Health Blvd
Suite 201
Myrtle Beach, SC 29579-4477
Phone (843) 646-8001
107 McLeod Health Blvd
Myrtle Beach, SC 29579-4477
115 McLeod Health Blvd
Myrtle Beach, SC 29579-4477
3793 McDowell LN
Little River, SC 29566-7892
3980 Hwy 9 E
Little River, SC 29566-8164
4000 Hwy 9 E
Little River, SC 29566-7833
Phone (843) 777-7000
4000 Hwy 9 W
Suite 245
Little River, SC 29566-7833
Phone (843) 366-2940
800 E Cheves St
Florence, SC 29506-2650
800 E Cheves St
Florence, SC 29506-2652
Hospital & facility affiliations
- McLeod Loris Hospital
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230731000114 | SC | Practitioner - Physician Assistant | 2163883778 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McLeod Physician Associates II | Current |
Accepting new patients | |
| McLeod Physician Associates II | Past | Accepting new patients |
Locations
506 E Cheves St
#202
Florence, SC 29506
Interoperability endpoints
- tbaucom25109@directmcleodehealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4861 | SC | Yes |
Addresses
Primary practice location
3793 McDowell LN
Medical Park 2, Suite 100
Little River, SC 29566
Mailing address
4917 Campobello Dr
Monroe, NC 28110
Phone (704) 221-6042
Other providers in Little River, SC
- Atlantic Urology Clinic LLC
- Atlantic Urology Clinics LLC
- Audiology Services Company USA, LLC
- Tara Harrison Aycock
- Genevieve Badaoui
- Laura Baxley
- Jerrilyn June Beasley
- James Bennett
- George E Berley
- Scott Morris Berry
All providers in Little River, SC · Physician Assistant 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 Jun 9, 2023. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.