NPIMap

Individual provider Active NPI

Xaimarie Santiago Gonzalez, M.D.

  • Internal Medicine Physician
  • Loris, SC
National Provider Identifier
1912438169
Registry record updated Aug 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
83903 Issued in SC
Practice address
3655 Mitchell St
Loris, SC 29569-2827
Phone
(843) 716-7000
NPI assigned
Mar 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 83903 SC Primary

Addresses

Primary practice location

3655 Mitchell St
Loris, SC 29569-2827

Mailing address

4000 Highway 9 E
Little River, SC 29566-7833

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
I20200917001578 SC Practitioner - Internal Medicine 7911284104 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLeod Loris Seacoast HospitalGroup PAC ID 9133394398, 57 clinicians

Practice addresses (Care Compare)

3655 Mitchell St
Loris, SC 29569-2827
Phone (843) 716-7111

4000 Hwy 9 E
Little River, SC 29566-7833
Phone (843) 390-8100

Hospital & facility affiliations

  • McLeod Loris Hospital Hospital, Loris, SC, CCN 420105
  • McLeod Regional Medical Center-Pee Dee Hospital, Florence, SC, CCN 420051
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
83903SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Loris Seacoast Hospital CurrentSince Aug 25, 2020 Accepting new patients
McLeod Loris Seacoast Hospital CurrentSince Aug 25, 2020 Accepting new patients
McLeod Loris Seacoast Hospital Past Accepting new patients

Locations

4000 Highway 9 E
Little River, SC 29566
Phone (843) 390-8100

3655 Mitchell St
Loris, SC 29569
Phone (843) 716-7000

Interoperability endpoints

  • Direct secure messaging: xsantiago26301@directmcleodehealth.org

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1912438169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 HIGHWAY 9 E",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295667833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 MITCHELL ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692827",
            "telephone_number": "843-716-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO GONZALEZ",
        "first_name": "XAIMARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-21",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "83903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loris, SC

Sources for this page

Verify at the official NPI Registry.