Individual provider Active NPI

John J Kudlak Jr., D.O.

  • Pulmonary Disease Physician
  • Greenville, SC
National Provider Identifier
1023064847
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
714 Issued in SC
Practice address
200 Patewood Dr
Suite B300
Greenville, SC 29615-3593
Phone
(864) 454-4200
Fax
(864) 454-4205
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 714 SC Primary

Addresses

Primary practice location

200 Patewood Dr
Suite B300
Greenville, SC 29615-3593

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 695-6697

Other identifiers 3

IdentifierTypeStateIssuer
P00265774OtherSCRR MEDICARE
P00801525OtherSCRAILROAD MEDICARE
007147MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031117000365 SC Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 6507770310 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
West Virginia School of Osteopathic Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

125 Professional Park Dr
Seneca, SC 29678-2558
Phone (864) 482-3000

135 Professional Park Dr
Seneca, SC 29678-2558
Phone (864) 882-5306

200 Fleetwood Dr
Easley, SC 29640-2022
Phone (864) 442-7618

200 Patewood Dr
Suite B300
Greenville, SC 29615-6338
Phone (864) 454-4200

210 Freeman Farm Rd
Duncan, SC 29334-9398
Phone (864) 968-5123

22725 Hwy 76 E
Clinton, SC 29325-7527
Phone (864) 833-4545

22725 US Hwy 76
Suite 3C
Clinton, SC 29325-7527
Phone (864) 833-3852

300 E McBee Ave
Greenville, SC 29601-2842
Phone (864) 797-6220

300 E McBee Ave FL
Suite 4
Greenville, SC 29601-2842

701 Grove Rd
Greenville, SC 29605-4210

727 SE Main St
Simpsonville, SC 29681-3248

807 N Main St
Travelers Rest, SC 29690-1551
Phone (864) 455-9261

815 N Main St
Travelers Rest, SC 29690-1551
Phone (864) 455-9261

817 N Main St
Travelers Rest, SC 29690-1551
Phone (864) 455-9790

830 S Buncombe Rd
Greer, SC 29650-2400
Phone (864) 455-2455

890 W Faris Rd
Suite 570
Greenville, SC 29605-5894
Phone (864) 455-1540

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
714SCMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Greenville Health System CurrentSince Sep 6, 2005 Accepting new patients
Prisma Health University Medical Group CurrentSince Jan 1, 2010 Accepting new patients
Prisma Health University Medical Group CurrentSince Jan 1, 2010 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jan 1, 2026 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jan 1, 2026 Accepting new patients

Locations

22725 US Highway 76
Clinton, SC 29325
Phone (864) 833-9100

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

100 Augusta St
Greenville, SC 29601
Phone (864) 455-2600

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

877 W Faris Rd
Ste C
Greenville, SC 29605
Phone (864) 455-8147

200 Patewood Dr
Ste B300
Greenville, SC 29615
Phone (864) 454-4200

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

200 Patewood Dr
Bldg A
Greenville, SC 29615
Phone (864) 454-2604

315 Medical Pkwy
Ste 200
Greer, SC 29650
Phone (864) 797-9550

719A SE Main St
Simpsonville, SC 29681
Phone (864) 967-9000

115 N Sumter St
Ste 315
Sumter, SC 29150
Phone (803) 774-9787

807 N Main St
Travelers Rst, SC 29690
Phone (864) 834-5132

Interoperability endpoints

  • Direct secure messaging: jkudlak7178@direct.ghs.myhfn.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 55

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765756800000",
    "number": "1023064847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-695-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "SUITE B300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-4200",
            "fax_number": "864-454-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDLAK",
        "first_name": "JOHN",
        "middle_name": "J",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "SC",
            "license": "714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00265774",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00801525",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007147",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.