NPIMap

Individual provider Active NPI

Rupa Ravindra Shetty, M.D.

  • Psychiatry Physician
  • Myrtle Beach, SC
National Provider Identifier
1962428235
Registry record updated Jun 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
27604 Issued in SC
Practice address
237 Avenue of the Palms
Myrtle Beach, SC 29579-1247
Phone
(843) 461-6133
Fax
(843) 347-6907
NPI assigned
Jul 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 27604 SC Primary
Child & Adolescent Psychiatry Physician 2084P0804X 27604 SC

Addresses

Primary practice location

237 Avenue of the Palms
Myrtle Beach, SC 29579-1247

Mailing address

237 Avenue of the Palms
Myrtle Beach, SC 29579-1247
Phone (843) 461-6133

Other identifiers 1

IdentifierTypeStateIssuer
1516445MedicaidSC

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
I20051130000256 SC Practitioner - PsychiatryPractitioner - Addiction MedicinePractitioner - Geriatric Psychiatry 8022064989 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Addiction Medicine, Geriatric Psychiatry
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

152 Waccamaw Medical Park Dr
Conway, SC 29526-8901
Phone (843) 461-6133

164 Waccamaw Medical Park Dr
Conway, SC 29526-8903
Phone (843) 347-5060

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rupa Shetty LLC Child & Adolescent Psychiatry CurrentSince Jul 2, 2010 Accepting new patients
South Carolina Dept of Mental Health Accounting Office CurrentSince Aug 16, 2011 Accepting new patients
South Carolina Dept of Mental Health Accounting Office CurrentSince Aug 16, 2011 Accepting new patients
HHC South Carolina Inc Past Accepting new patients

Locations

164 Waccamaw Medical Park Dr
Conway, SC 29526
Phone (843) 347-4888

152 Waccamaw Medical Park Dr
Conway, SC 29526
Phone (843) 347-8871

Organizations & group practices 4

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1962428235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 AVENUE OF THE PALMS",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295791247",
            "telephone_number": "843-461-6133",
            "fax_number": "843-347-6907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 AVENUE OF THE PALMS",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295791247",
            "telephone_number": "843-461-6133",
            "fax_number": "843-347-6907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETTY",
        "first_name": "RUPA",
        "middle_name": "RAVINDRA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "27604",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "SC",
            "license": "27604",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1516445",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.