NPIMap

Organization Active NPI

Mary Black Physicians Group, LLC

  • Internal Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1013152669
Registry record updated Dec 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARY BLACK PHYSICIANS GROUP, LLC
Practice address
1690 Skylyn Dr
Suite 300
Spartanburg, SC 29307-1022
Phone
(864) 342-4000
NPI assigned
Dec 11, 2008
Last updated
Dec 11, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY BLACK PHYSICIANS GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debbie Brewer
Title
Director Provider Enrollment
Phone
(615) 465-7626

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

1690 Skylyn Dr
Suite 300
Spartanburg, SC 29307-1022

Mailing address

PO Box 277827
Atlanta, GA 30384-7827
Phone (864) 253-8080

Other identifiers 1

IdentifierTypeStateIssuer
GP4765MedicaidSC

Other names 1

  • Piedmont Internal Medicine-East Other name

National Provider Directory

National Provider Directory
Tax ID family
Emary Black Physicians Group LLC33 organizations share this tax ID, including this one
Part of
Emary Black Physicians Group LLC

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228953600000",
    "number": "1013152669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277827",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303847827",
            "telephone_number": "864-253-8080",
            "fax_number": "864-582-5188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 SKYLYN DR",
            "address_2": "SUITE 300",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071022",
            "telephone_number": "864-342-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK PHYSICIANS GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK PHYSICIANS GROUP, LLC",
        "enumeration_date": "2008-12-11",
        "last_updated": "2008-12-11",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4765",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Piedmont Internal Medicine-East",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.