NPIMap

Organization Active NPI

Tidewater Neurology

  • Specialist
  • Mt Pleasant, SC
National Provider Identifier
1962454124
Registry record updated Nov 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
19697 Issued in SC
Legal business name
TIDEWATER NEUROLOGY
Practice address
913 B Bowman Rd
Mt Pleasant, SC 29464-3235
Phone
(843) 856-9530
Fax
(843) 971-1345
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2007

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

Authorized official

Name
Thomas Sanders Hughes, MDNPI 1831379213
Title
Owner
Phone
(843) 856-9530

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 19697 SC Primary

Addresses

Primary practice location

913 B Bowman Rd
Mt Pleasant, SC 29464-3235

Mailing address

913 B Bowman Rd
Mt Pleasant, SC 29464-3235
Phone (843) 856-9530

Other identifiers 1

IdentifierTypeStateIssuer
GP4157MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050513000108 SC Part B Supplier - Clinic/Group Practice 0244271831 Receives reassigned benefits from 3 practitioners
Practice locations: Mt Pleasant, SC

National Provider Directory

National Provider Directory

Locations

1483 Tobias Gadson Blvd
Ste 107
Charleston, SC 29407
Phone (843) 402-0367

913 Bowman Rd
Ste 105
Mt Pleasant, SC 29464
Phone (843) 856-9530

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1962454124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 B BOWMAN RD",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643235",
            "telephone_number": "843-856-9530",
            "fax_number": "843-971-1345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 B BOWMAN RD",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643235",
            "telephone_number": "843-856-9530",
            "fax_number": "843-971-1345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "SANDERS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-856-9530",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": "19697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4157",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.