GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A.
NPI 1588614192
Pediatrics - Adolescent Medicine in Myrtle Beach, SC
NPI Status: Active since May 12, 2006
Contact Information
8120 ROURK ST
MYRTLE BEACH, SC
ZIP 29572
Phone: (843) 449-1438
Fax: (843) 286-1349
NPPES record last updated: February 25, 2014. Verified against the NPPES registry weekly; last sync: July 12, 2026.
- Organization
- Pediatrics
- Adolescent Medicine
- Accepts Insurance
- CLIA Number: 42D0251967
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-18-2028
About GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A.
This page provides the complete NPI Profile along with additional information for Grand Strand Pediatrics & Adolescent Medicine, P.a., a pediatrician established in Myrtle Beach, South Carolina operating as a Pediatrics, focusing in adolescent medicine . The healthcare provider is registered in the NPI registry with number 1588614192 assigned on May 2006. The practitioner's primary taxonomy code is 2080A0000X with license number 7085 (SC). The provider is registered as an organization and their NPI record was last updated 12 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Dr. Thomas W Petrusick Md (Owner/physician)
- NPI
- 1588614192
- Provider Name
- GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A.
- Entity Type
- Organization
- Location Address
- 8120 ROURK ST MYRTLE BEACH, SC 29572
- Location Phone
- (843) 449-1438
- Location Fax
- (843) 286-1349
- Mailing Address
- 8120 ROURK ST MYRTLE BEACH, SC 29572
- Mailing Phone
- (843) 449-1438
- Mailing Fax
- (843) 286-1349
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-12-2006
- Last Update Date
- 02-25-2014
- Code Navigator
A pediatrician like Grand Strand Pediatrics & Adolescent Medicine, P.a. is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pediatrics Adolescent Medicine
- Taxonomy Code
- 2080A0000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 7085
- License State
- SC
- Taxonomy Description
- A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Direction Bronze 1 - POS
- Blue Direction Silver 1 - POS
- Blue Direction Silver 1 + Adult Vision - POS
- Blue Direction Silver 2 - POS
- Blue Direction Standard Expanded Bronze - POS
- Blue Direction Standard Gold - POS
- Blue Direction Standard Silver - POS
- Blue VirtuConnect Bronze 1 - EPO
- Blue VirtuConnect Gold 1 - EPO
- Blue VirtuConnect Silver 1 - EPO
- BlueEssentials Bronze 4 - EPO
- BlueEssentials Bronze 6 - EPO
- BlueEssentials Gold 1 - EPO
- BlueEssentials Gold 5 - EPO
- BlueEssentials Silver 14 - EPO
- BlueEssentials Silver 14 + Adult Vision - EPO
- BlueEssentials Silver 40 - EPO
- BlueEssentials Standard Expanded Bronze - EPO
- BlueEssentials Standard Gold - EPO
- BlueEssentials Standard Silver - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| ========= | OTHER (01) | SC | FED ID# |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 42D0251967
- Facility Type
- Physician Office
- Certificate Effective Date
- April 19, 2026
- Certificate Expiration Date
- April 18, 2028
- Laboratory Director
- DR. FRANK N. COLVARD
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Grand Strand Pediatrics & Adolescent Medicine, P.a. after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
Reviews for GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A.
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1588614192, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 68. The final step is to find the difference between that total and the next multiple of ten (70 - 68 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 68 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 12 providers are registered at the same or a nearby location.
MYRTLE BEACH, SC 29572
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1588614192, enumerated as an "organization" on May 12, 2006.
The provider is located at 8120 ROURK ST MYRTLE BEACH, SC 29572 and the phone number is (843) 449-1438.
Pediatrics with taxonomy code 2080A0000X and a focus in Adolescent Medicine.
The provider might be accepting Accepts: BlueCross BlueShield of South Carolina, Medicare. Please consult your insurance carrier or call the provider to verify.
