Active NPI
Gregor G Cleveland, MD
- Diagnostic Radiology Physician
- Myrtle Beach, SC
National Provider Identifier
1942297635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 15902
- Practice address
- 1303 Azalea CT
Suite C
Myrtle Beach, SC 29577-5765 - Phone
- (843) 692-0570
- Fax
- (843) 497-9566
- NPI assigned
- Sep 29, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 15902 | SC | Primary |
Addresses
Primary practice location
1303 Azalea CT
Suite C
Myrtle Beach, SC 29577-5765
Mailing address
1303 Azalea CT
Ste C
Myrtle Beach, SC 29577-5765
Phone (843) 692-0570
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60773 | Other | SC | MEDCOST |
| 05905 | Other | NC | BCBS OF NC |
| 154758900 | Other | SC | FEDERAL BLACK LUNG |
| 570525838 | Other | SC | STANDARD TAX ID |
| 890603R | Other | NC | MEDICAID OF NC |
| 300049800 | Other | SC | RAILROAD MEDICARE |
| 159027 | Medicaid | SC | |
| 154758900 | Other | SC | US DEPT OF LABOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473724800000",
"number": "1942297635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1303 AZALEA CT",
"address_2": "STE C",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295775765",
"telephone_number": "843-692-0570",
"fax_number": "843-497-9566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1303 AZALEA CT",
"address_2": "SUITE C",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295775765",
"telephone_number": "843-692-0570",
"fax_number": "843-497-9566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVELAND",
"first_name": "GREGOR",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-29",
"last_updated": "2016-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "SC",
"license": "15902",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "60773",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC",
"identifier": "05905",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLACK LUNG",
"identifier": "154758900",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STANDARD TAX ID",
"identifier": "570525838",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID OF NC",
"identifier": "890603R",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "300049800",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "159027",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF LABOR",
"identifier": "154758900",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
- Cameron Clements, FNP
- Clemson Sports Medicine and Rehabilitation
- Clemson Sports Medicine and Rehabilitation
- Clemson Sports Medicine and Rehabilitation Inc
- Clemson Sports Medicine and Rehabilitation, Inc.
- Kacee L Cleveland, LPC
- Alayna K Cline, OTR/L
- Danielle Marie Cline
- Laura Kathryn Close
- Clover Therapy Center, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.