TIDEWATER DOCTORS LLC
NPI 1992474654
Family Medicine in Charleston, SC
About Tidewater Doctors Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TIDEWATER DOCTORS LLC (NPI 1992474654) is a healthcare organization registered as a family medicine in Charleston, South Carolina and active in the NPI registry since September 2021. The organization maintains a secondary practice location in Charleston and lists Andrea Hurley, Practice Administrator, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Tidewater Doctors Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Tidewater Doctors LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
Charleston, SC 29414
Charleston, SC 29414
Charleston, SC 29414
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tidewater Doctors LLC's NPI number?
The NPI number for Tidewater Doctors LLC is 1992474654. It was assigned to this organization in the NPPES registry on September 7, 2021.
Where is Tidewater Doctors LLC located?
Tidewater Doctors LLC is located at 2270 Ashley Crossing Dr Ste 150, Charleston, SC 29414. The listed phone number is (843) 766-1936.
What is Tidewater Doctors LLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Tidewater Doctors LLC enrolled in Medicare?
Yes. Tidewater Doctors LLC is registered in the Medicare PECOS enrollment system.
When is Tidewater Doctors LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (South Carolina, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Tidewater Doctors LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Tidewater Doctors LLC, in Family Practice and Internal Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Tidewater Doctors LLC accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, BlueCross BlueShield of South Carolina and Molina Healthcare list Tidewater Doctors LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Tidewater Doctors LLC was last updated on September 7, 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.
# Tidewater Doctors Llc · NPI 1992474654
Family Medicine organization in Charleston, South Carolina. Organization record, active in the CMS NPPES registry since September 7, 2021.
## Identity
- **NPI:** 1992474654 (Entity type: Organization)
- **Enumerated:** September 7, 2021
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Andrea Hurley, PRACTICE ADMINISTRATOR
## Practice location
- **Address:** 2270 ASHLEY CROSSING DR STE 150, Charleston, SC 29414-5702
- **Phone:** (843) 766-1936 · **Fax:** (843) 766-1206
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, South Carolina, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (2), Internal Medicine (1); 3 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 7, 2021
---
Source: [NPI Profile](https://npiprofile.com/npi/1992474654) · Data from the CMS NPPES public registry.