MR. LISTON ALEXANDER WEATHERLY JR. APRN
NPI 1912413832
Nurse Practitioner in Hartsville, SC

Q: What is Liston Weatherly's NPI number?

The NPI number for Liston Weatherly is 1912413832. It was assigned to this individual provider in the NPPES registry on December 15, 2017.

Q: What is Liston Weatherly's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Liston Weatherly was last updated on September 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 15, 2017PECOS EnrolledAccepts Medicare Assignment

1268 S 4TH ST, HARTSVILLE, SC 29550(803) 484-5317 Get Directions Write a Review

NPPES record last updated: September 22, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 22, 2021, Dec 15, 2017 (2 updates tracked since 2017).

On this page

About Mr. Liston Alexander Weatherly Jr. Aprn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. LISTON ALEXANDER WEATHERLY JR. APRN (NPI 1912413832) is an individual nurse practitioner in Hartsville, South Carolina, licensed in South Carolina (21363) and active in the NPI registry since December 2017. He is enrolled in Medicare PECOS, is affiliated with Carolina Pines Regional Medical Center, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1912413832

Entity TypeIndividualMale

Primary Taxonomy363L00000X

Provider Legal NameMR. LISTON ALEXANDER WEATHERLY JR.Credential: APRN

Location Address1268 S 4TH STHartsville, SC 29550-0703

Mailing AddressPo Box 1090Hartsville, SC 29551-1090 · (843) 857-0111

Phone(803) 484-5317

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateDecember 15, 2017

Last NPPES UpdateSeptember 22, 20212 updates tracked since enumeration

NPPES CertifiedSeptember 22, 2021

✔ NPI 1912413832 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in SC · 21363

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

1268 S 4TH ST, Hartsville, SC 29550

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of South Carolina, First Choice Next, InStil Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Liston Alexander Weatherly Jr. Aprn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9436411188

PECOS Enrollment IDI20180319000505

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Liston Weatherly reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Caresouth Carolina, Inc.

Same address

Federally Qualified Health Center (FQHC)

1268 S 4TH ST
Hartsville, SC 29550

Reassigned Medicare billing, South Carolina enrollment
95 clinicians in this Medicare group

NPI 1720082571 (843) 332-3422

Hartsville Medical Group LLC

2.5 mi

Internal Medicine

701 MEDICAL PARK DR
Hartsville, SC 29550

Reassigned Medicare billing, South Carolina enrollment
116 clinicians in this Medicare group

NPI 1598995300 (843) 383-5191

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

72 services34 patients

Detection test by immunoassay with direct visual observation for influenza virus 87804

This is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.

28 services13 patients

Automated urinalysis test 81003

An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.

18 services13 patients

Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus 87426

An immunoassay test for severe acute respiratory syndrome coronavirus is a diagnostic tool. It uses your body's immune response to detect the presence of the virus. It involves taking a sample, usually from your nose or throat, which is then analyzed in a lab for signs of the virus.

16 services15 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Carolina Pines Regional Medical Center

Acute Care Hospitals · Hartsville, SC

3/5 CMS rating

OwnershipProprietary

CMS Certification Number420010

Location1304 W Bobo Newsom HwyHartsville, SC 29550 · Darlington County

Emergency services Birthing friendly

Mcleod Regional Medical Center-Pee Dee

Acute Care Hospitals · Florence, SC

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number420051

Location555 E Cheves St Box 8700Florence, SC 29506 · Florence County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29550 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.18 typical visit price

range $53.57 – $163.84

Typical copayment $20.79 (range $13.39 – $40.96)

Most-billed visit code 99203

Established Patient

$95.12 typical visit price

range $16.96 – $133.52

Typical copayment $23.78 (range $4.24 – $33.38)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. ZITA ACUNA ANDRESKI APRN FNP-C

Nurse Practitioner (Family)