NPIMap

Individual provider Active NPI

Ricky L Kidman, PA-C

  • Medical Physician Assistant
  • Aynor, SC
National Provider Identifier
1962466532
Registry record updated Aug 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1094 Issued in SC
Practice address
51 11TH Avenue
Aynor, SC 29511-3249
Phone
(843) 358-3700
Fax
(843) 358-3707
NPI assigned
Apr 12, 2006
Last updated
Aug 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

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
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

Merit-based Incentive Payment System (MIPS)

Final score
52.78 of 100Reported as group
Quality
55.48
Improvement activities
0
Cost
74.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1094SCMDSports Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Hospital Community Services CurrentSince Nov 18, 2023 Accepting new patients
Conway Hospital Community Services Medical CurrentSince Nov 18, 2023 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aynor, SC

Sources for this page

Verify at the official NPI Registry.