Active NPI
Ricky L Kidman, PA-C
- Medical Physician Assistant
- Aynor, SC
National Provider Identifier
1962466532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1094
- Practice address
- 51 11TH Avenue
Aynor, SC 29511-3249 - Phone
- (843) 358-3700
- Fax
- (843) 358-3707
- NPI assigned
- Apr 12, 2006
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1094 | SC | Primary |
Addresses
Primary practice location
51 11TH Avenue
Aynor, SC 29511-3249
Mailing address
300 Singleton Ridge Rd
Attention PNS Credentialing
Conway, SC 29526-9142
Phone (843) 234-6946
Other practice location 1
1213 Elm St
Aynor, SC 29511-3320
Phone (843) 358-5806
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1140PA | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061128000420 | SC | Practitioner - Physician Assistant | 9032117122 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of Nebraska College of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1213 Elm St
Aynor, SC 29511-3320
Phone (843) 358-5806
300 Singleton Ridge Rd
Conway, SC 29526-9142
51 11TH Ave
Aynor, SC 29511-3249
Phone (843) 358-3700
Hospital & facility affiliations
- Amedisys Home Health of Conway
- Conway Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 52.78 of 100
- Quality
- 55.48
- Improvement activities
- 0
- Cost
- 74.21
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1094 | SC | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conway Hospital Community Services | Current | Accepting new patients | |
| Conway Hospital Community Services | Medical | Current | Accepting new patients |
| Conway Hospital Community Services | Past | Accepting new patients | |
| Marion Regional Healthcare System | Internal Medicine | Past | Accepting new patients |
Locations
1213 Elm St
Aynor, SC 29511
Phone (843) 358-5806
51 11th Ave
Aynor, SC 29511
Phone (843) 358-3700
300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946
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.
-
- Rural Health Clinic/Center
- Aynor, SC
- NPI 1467772400
-
- Rural Health Clinic/Center
- Mullins, SC
- NPI 1972553691
Internal Medicine
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Conway, SC
- NPI 1316905573
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755734400000",
"number": "1962466532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 SINGLETON RIDGE RD",
"address_2": "ATTENTION PNS CREDENTIALING",
"city": "CONWAY",
"state": "SC",
"postal_code": "295269142",
"telephone_number": "843-234-6946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 11TH AVENUE",
"city": "AYNOR",
"state": "SC",
"postal_code": "295113249",
"telephone_number": "843-358-3700",
"fax_number": "843-358-3707"
}
],
"practiceLocations": [
{
"address_1": "1213 Elm St",
"address_purpose": "LOCATION",
"city": "Aynor",
"state": "SC",
"postal_code": "295113320",
"country_code": "US",
"telephone_number": "843-358-5806",
"fax_number": "843-358-9205",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIDMAN",
"first_name": "RICKY",
"middle_name": "L",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2025-08-21",
"certification_date": "2025-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "SC",
"license": "1094",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1140PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aynor, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.