NPIMap

Organization Active NPI

360 Health Care

  • Medical Specialty Clinic/Center
  • Myrtle Beach, SC
National Provider Identifier
1962881268
Registry record updated May 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
MD18446 Issued in SC
Legal business name
360 HEALTH CARE
Practice address
4810 N Kings Hwy
Myrtle Beach, SC 29577-2558
Phone
(843) 692-9243
NPI assigned
May 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2015

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

Authorized official

Name
Dr. Jin Li DongNPI 1518912286
Title
Owner
Phone
(843) 692-9243

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 27 SC
Medical Specialty Clinic/Center 261QM2500X MD18446 SC Primary

Addresses

Primary practice location

4810 N Kings Hwy
Myrtle Beach, SC 29577-2558

Mailing address

4810 N Kings Hwy
Myrtle Beach, SC 29577-2558
Phone (843) 692-9243

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150827001289 SC Part B Supplier - Clinic/Group Practice 4183930795 Receives reassigned benefits from 3 practitioners
Practice locations: Myrtle Beach, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1432080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1962881268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4810 N KINGS HWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295772558",
            "telephone_number": "843-692-9243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 N KINGS HWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295772558",
            "telephone_number": "843-692-9243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-20",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "DONG",
        "authorized_official_first_name": "JIN",
        "authorized_official_middle_name": "LI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-692-9243",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "SC",
            "license": "27",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "SC",
            "license": "MD18446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; 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.