ANGELIC PRIMARY MEDICINE OF SC, LLC
NPI 1730752015
Nurse Practitioner - Primary Care in Myrtle Beach, SC
NPI Status: Active since July 23, 2021
Contact Information
4728 JENN DR STE 102
MYRTLE BEACH, SC
ZIP 29577
Phone: (609) 464-1135
Fax: (609) 822-7980
- Organization
- Nurse Practitioner
- Primary Care
- Accepts Insurance
- CLIA Number: 31D2195398
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 10-07-2026
About ANGELIC PRIMARY MEDICINE OF SC, LLC
This page provides the complete NPI Profile along with additional information for Angelic Primary Medicine Of Sc, Llc, a provider established in Myrtle Beach, South Carolina operating as a Nurse Practitioner, focusing in primary care . The healthcare provider is registered in the NPI registry with number 1730752015 assigned on July 2021. The practitioner's primary taxonomy code is 363LP2300X. The provider is registered as an organization and their NPI record was last updated one year 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 Janet Gibson Apn (Owner)
- NPI
- 1730752015
- Provider Name
- ANGELIC PRIMARY MEDICINE OF SC, LLC
- Entity Type
- Organization
- Location Address
- 4728 JENN DR STE 102 MYRTLE BEACH, SC 29577
- Location Phone
- (609) 464-1135
- Location Fax
- (609) 822-7980
- Mailing Address
- 8025 BLACK HORSE PIKE STE 501 PLEASANTVILLE, NJ 08232
- Mailing Phone
- (609) 822-7979
- Mailing Fax
- (609) 822-7980
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-23-2021
- Last Update Date
- 06-26-2025
- Code Navigator
A nurse practitioner (NP) like Angelic Primary Medicine Of Sc, Llc is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, 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
Nurse Practitioner Primary Care
- Taxonomy Code
- 363LP2300X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
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:
- First Choice Next Bronze Essential - HMO
- First Choice Next Bronze Premier - HMO
- First Choice Next Bronze Signature - HMO
- First Choice Next Gold Premier - HMO
- First Choice Next Gold Signature - HMO
- First Choice Next Silver Essential - HMO
- First Choice Next Silver Premier - HMO
- First Choice Next Silver Signature - HMO
- Molina Gold Core 1640 - HMO
- Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
- Molina Gold Core 1640 Plus with Adult Vision - HMO
- Molina Gold Standard - HMO
- Molina Gold Value - HMO
- Molina Gold Value Plus with Adult Dental and Vision - HMO
- Molina Gold Value Plus with Adult Vision - HMO
- Molina Silver Core - HMO
- Molina Silver Core Plus with Adult Dental and Vision - HMO
- Molina Silver Core Plus with Adult Vision - HMO
- Molina Silver Saver - HMO
- Molina Silver Standard - HMO
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 |
|---|---|---|---|
| 24726 | OTHER (01) | SC | LICENSE |
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
- 31D2195398
- Facility Type
- Practitioner Other
- Certificate Effective Date
- October 08, 2024
- Certificate Expiration Date
- October 07, 2026
- Laboratory Director
- MELISSA MORDESAI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Angelic Primary Medicine Of Sc, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI 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 1730752015, we treat the final digit (5) 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 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).
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 55 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1730752015, enumerated as an "organization" on July 23, 2021.
The provider is located at 4728 JENN DR STE 102 MYRTLE BEACH, SC 29577 and the phone number is (609) 464-1135.
Nurse Practitioner with taxonomy code 363LP2300X and a focus in Primary Care.
The provider might be accepting Accepts: First Choice Next, Molina Healthcare, Medicare and. Please consult your insurance carrier or call the provider to verify.
