Main Street Medical PC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

18011 Issued in SC

Legal business name

MAIN STREET MEDICAL PC

Practice address

93 Main St
Hilton Head, SC 29926-1648

Phone

(843) 681-3777

Fax

(843) 681-9996

NPI assigned

Oct 3, 2006

Last updated

Jan 15, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Joel Mandus Johnson III, M.D.NPI 1619902442

Title

Ceo Doctor

Phone

(843) 681-3777

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EHFHBD

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joel M Johnson III, MD

  • Family Medicine Physician
  • Hilton Head, SC
  • NPI 1619902442
  Medicare reassignment Care Compare group NPD Authorized official
• Van Alan Gauby, MD

  • Family Medicine Physician
  • Hilton Head, SC
  • NPI 1811945355
  Medicare reassignment Care Compare group NPD
• Nicole Lee Clegg, APRN, FNP-C

  • Family Nurse Practitioner
  • Hilton Head Island, SC
  • NPI 1033873450
  Medicare reassignment NPD
• Francis C Imbarrato, MD

  • Family Medicine Physician
  • Hilton Head, SC
  • NPI 1548214612
  Medicare reassignment NPD
• Lydia C Torres-Rozof, MD

  • Family Medicine Physician
  • Hilton Head Island, SC
  • NPI 1770678096
  Medicare reassignment NPD
• Amanda Paige Wooten, AGPCNP-BC

  • Adult Health Nurse Practitioner
  • Bluffton, SC
  • NPI 1013610864
  Medicare reassignment NPD
• Eric Rayburn

  • Physician Assistant
  • Wilmington, NC
  • NPI 1528160546

  SC

  Medicare reassignment
• Amber Lauren Graham

  • Nurse Practitioner
  • Hilton Head Island, SC
  • NPI 1790636355
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1922192194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 MAIN ST",
            "city": "HILTON HEAD",
            "state": "SC",
            "postal_code": "299261648",
            "telephone_number": "843-681-3777",
            "fax_number": "843-681-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 MAIN ST",
            "city": "HILTON HEAD",
            "state": "SC",
            "postal_code": "299261648",
            "telephone_number": "843-681-3777",
            "fax_number": "843-681-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "MANDUS",
        "authorized_official_title_or_position": "CEO DOCTOR",
        "authorized_official_telephone_number": "843-681-3777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "SC",
            "license": "18011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lymin Inc (Miracle Ear)
• Kimberly Ann Mackay-Pearson, LPC
• Linda J Magid, PTA
• Main Street Chiropractic of Hilton Head, Inc.
• Main Street Health Center LLC
• Jalen Maxell Manor, FNP-C
• Lourdes Martinez
• Match Point Hilton Head LLC (Synergy HomeCare of the Lowcountry)
• Matthew Mastrorocco DMD, PA
• David E Maurer, M.D.

• Multi-Specialty Clinic/Center in Hilton Head, SC
• Providers in Hilton Head, SC by specialty
• Multi-Specialty Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.