Coastal Carolina Primary Care, Llc - Medicare Primary Care in Myrtle Beach, SC

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Coastal Carolina Primary Care, Llc is a medicare enrolled primary clinic (Internal Medicine - Endocrinology, Diabetes & Metabolism) in Myrtle Beach, South Carolina. The current practice location for Coastal Carolina Primary Care, Llc is 920 Doug White Dr Ste 250, Myrtle Beach, South Carolina. For appointments, you can reach them via phone at (843) 236-1950. The mailing address for Coastal Carolina Primary Care, Llc is 2000 Health Park Dr, Brentwood, Tennessee and phone number is (615) 372-5426.

Coastal Carolina Primary Care, Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1821257676. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (843) 236-1950.

Contact Information

Coastal Carolina Primary Care, Llc
920 Doug White Dr Ste 250
Myrtle Beach
SC 29572-4181
(843) 236-1950
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameCoastal Carolina Primary Care, Llc
SpecialityInternal Medicine
Location920 Doug White Dr Ste 250, Myrtle Beach, South Carolina
Authorized Official Name and PositionWilliam Tedrick Johnson (VICE PRESIDENT)
Authorized Official Contact6153723375
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Coastal Carolina Primary Care, Llc
2000 Health Park Dr
Brentwood
TN 37027-4692

Ph: (615) 372-5426		Coastal Carolina Primary Care, Llc
920 Doug White Dr Ste 250
Myrtle Beach
SC 29572-4181

Ph: (843) 236-1950

NPI Details:

NPI Number1821257676
Provider Enumeration Date06/06/2008
Last Update Date12/29/2021

Medicare PECOS Information:

Medicare PECOS PAC ID3577629088
Medicare Enrollment IDO20090309000437

Medical Identifiers

Medical identifiers for Coastal Carolina Primary Care, Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1821257676NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207RE0101XInternal Medicine - Endocrinology, Diabetes & Metabolism (* (Not Available))Primary
207V00000XObstetrics & Gynecology (* (Not Available))Secondary
2084P0800XPsychiatry & Neurology - Psychiatry (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Coastal Carolina Primary Care, Llc acts as a billing entity for following providers:
Provider NameBrandi D Hardin
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1891740510
PECOS PAC ID: 4385636000
Enrollment ID: I20040401001278
Provider NameRobert E Kimpton
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1407916133
PECOS PAC ID: 4385628445
Enrollment ID: I20040616000299
Provider NameKristine Dee Boyd
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1043251291
PECOS PAC ID: 4082682984
Enrollment ID: I20040920000126
Provider NameChris Boggs
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1326068362
PECOS PAC ID: 4082674015
Enrollment ID: I20041014000457
Provider NameElizabeth Norene Dacus
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1821013632
PECOS PAC ID: 6002811049
Enrollment ID: I20060925000515
Provider NameSean L Gibbs
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1215010020
PECOS PAC ID: 6800893629
Enrollment ID: I20061108000374
Provider NameCharles G Shissias
Provider TypePractitioner - Neurology
Provider IdentifiersNPI Number: 1124039334
PECOS PAC ID: 6608965710
Enrollment ID: I20071127000603
Provider NameKevin W Shea
Provider TypePractitioner - Infectious Disease
Provider IdentifiersNPI Number: 1265474324
PECOS PAC ID: 2466542733
Enrollment ID: I20091229000045
Provider NameSharai Correll Amaya
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1437279254
PECOS PAC ID: 7315071206
Enrollment ID: I20110401000362
Provider NameNancy Burgess Stroud
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1053398420
PECOS PAC ID: 1951207430
Enrollment ID: I20120914000067
Provider NameSanjay C Patwardhan
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1679886741
PECOS PAC ID: 3375785819
Enrollment ID: I20130812000787
Provider NameChristina Lynn
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1700014248
PECOS PAC ID: 0749429181
Enrollment ID: I20131015001787
Provider NameHarish Mangipudi
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1891923181
PECOS PAC ID: 8729211172
Enrollment ID: I20140509000372
Provider NameJilian Rinehart Sansbury
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1295097491
PECOS PAC ID: 1456573393
Enrollment ID: I20150622002326
Provider NameJerry B Banks
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1578552410
PECOS PAC ID: 1052224037
Enrollment ID: I20150721001829
Provider NameVictor E Collier
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1396782900
PECOS PAC ID: 0345394052
Enrollment ID: I20160125002884
Provider NameSarah B Ferrillo
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1447609060
PECOS PAC ID: 7214221001
Enrollment ID: I20160802000756
Provider NameMark G Gobin
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1932140092
PECOS PAC ID: 0941342232
Enrollment ID: I20160831001826
Provider NameDonna Bennett
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1568446995
PECOS PAC ID: 8123066776
Enrollment ID: I20170222001844
Provider NameJoshua C Brown
Provider TypePractitioner - Neurology
Provider IdentifiersNPI Number: 1851706980
PECOS PAC ID: 2961729611
Enrollment ID: I20170418001723
Provider NameMichael Shangte Liao
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1952346256
PECOS PAC ID: 7719087451
Enrollment ID: I20180328001111
Provider NameStephen Meyer
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1538573670
PECOS PAC ID: 1759662125
Enrollment ID: I20181116000051
Provider NameBrittany Stofko
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1659576767
PECOS PAC ID: 6800064080
Enrollment ID: I20181120001658
Provider NameBrandon K Lilly
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1992191472
PECOS PAC ID: 7810277720
Enrollment ID: I20190801001508
Provider NameManasi S Patwardhan
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1487846507
PECOS PAC ID: 4082838974
Enrollment ID: I20190806000378
Provider NameAnthony L Shadiack
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1427328533
PECOS PAC ID: 2668616012
Enrollment ID: I20190820001362
Provider NameNancy Elizabeth Crossley
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1336108943
PECOS PAC ID: 2062447790
Enrollment ID: I20200207002095
Provider NameTara Davis-boyd
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1033749643
PECOS PAC ID: 9335578384
Enrollment ID: I20200326003177
Provider NameDonald Courtney
Provider TypePractitioner - Hospice/palliative Care
Provider IdentifiersNPI Number: 1265490379
PECOS PAC ID: 9739319070
Enrollment ID: I20200401003459
Provider NameCaroljane Blanchard Roberson
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1932558061
PECOS PAC ID: 8325461866
Enrollment ID: I20200701000284
Provider NameEdith Bostic
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1235773326
PECOS PAC ID: 1658788443
Enrollment ID: I20210323001076
Provider NameJamie Alexis Weaver Campbell
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1750813481
PECOS PAC ID: 7113204231
Enrollment ID: I20210712003536
Provider NameTyler Clark Kilgore
Provider TypePractitioner - Hospice/palliative Care
Provider IdentifiersNPI Number: 1831544154
PECOS PAC ID: 5395031306
Enrollment ID: I20210902000588
Provider NameJennifer Marie Shierlock
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1841671344
PECOS PAC ID: 8426454869
Enrollment ID: I20210909002000
Provider NameAndrew Michael Futterman
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1548780653
PECOS PAC ID: 9335415306
Enrollment ID: I20211014003032
Provider NameAshley Collins
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1457747933
PECOS PAC ID: 1254671191
Enrollment ID: I20211221000741
Provider NameHeather Leslie-brown
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1215026570
PECOS PAC ID: 8325187404
Enrollment ID: I20220917000265
Provider NameMarchant Woodhouse Van Gerpen
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1396791794
PECOS PAC ID: 5193783850
Enrollment ID: I20230117000578
Provider NameRosalyn Barney
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1508511569
PECOS PAC ID: 2062884943
Enrollment ID: I20230202003390
Provider NameRobert Christian Lee Olson
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1285193540
PECOS PAC ID: 3678809506
Enrollment ID: I20230828000262
Provider NameMaria Ines Pereyra Heyward
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1619654142
PECOS PAC ID: 1658725502
Enrollment ID: I20230926001923
Provider NameMallikarjuna Bagewadi Ellur
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1790125615
PECOS PAC ID: 1557633187
Enrollment ID: I20231213001043
Provider NameBradley Rene Martin
Provider TypePractitioner - Critical Care (intensivists)
Provider IdentifiersNPI Number: 1487639456
PECOS PAC ID: 4385623057
Enrollment ID: I20240311002190

Reviews and Comments


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Jga Medical Ventures, P.c.
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Phone: 843-828-3352    Fax: 843-357-1471

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.