NPIMap

Organization Active NPI

Prisma Health-Upstate

Doing business as Prisma Health Vascular Health Alliance

  • General Acute Care Hospital
  • Greenville, SC
National Provider Identifier
1033664909
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
HTL-0933 Issued in SC
Legal business name
PRISMA HEALTH-UPSTATE
Doing business as
Prisma Health Vascular Health Alliance
Practice address
200 Patewood Dr
Suite C300
Greenville, SC 29615-3593
Phone
(864) 454-8272
NPI assigned
Aug 22, 2016
Last updated
Feb 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2021

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

Authorized official

Name
Polly H. Miller
Title
VP Payor Strategies & Alignment
Phone
(864) 522-2286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HTL-0933 SC Primary

Addresses

Primary practice location

200 Patewood Dr
Suite C300
Greenville, SC 29615-3593

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 455-7000

Other names 1

  • Prisma Health Vascular Health Alliance Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161118001439 SC Part A Provider - Hospital 5698063162 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, SC
O20161222000767 SC Part B Supplier - Clinic/Group Practice 5698063162 Receives reassigned benefits from 438 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, SC; Greer, SC; Seneca, SC; Simpsonville, SC; Spartanburg, SC; Travelers Rest, SC; Clinton, SC; Easley, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033664909. Details of each certification follow.

Hospital certification: CCN 420102

Legal name
PRISMA HEALTH-UPSTATE
Doing business as
PRISMA HEALTH PATEWOOD HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 12, 2007
Last certification
Dec 9, 2021
Beds
72
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 2016 (1 total)
Organization structure
OtherNon-profit
Incorporated
Apr 1, 2019 in SC
Enrollment address
175 Patewood Dr
Greenville, SC 29615-3570
Other Hospital Practice Location
Hospital subgroups
Short-term

Other NPIs on the same Medicare enrollment 43

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 43

Care Compare: Hospital

Medicare Care Compare
Listed as
Prisma Health Patewood HospitalCCN 420102 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
PH Laurens County Hospital122 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristi a Lawrence Individual W-2 Managing EmployeeDirector Provider Enrollment & Cvo Apr 5, 2020 100%
Polly H Miller Individual Corporate OfficerSVP Finance, Enterprise Contracting Mar 20, 2020 100%
W-2 Managing EmployeeSVP Finance, Enterprise Contracting Mar 20, 2020 100%
Prisma Health-Upstate Organization, Greenville, SC Created for acquisition 5% Or Greater Direct Ownership Interest Oct 1, 2016 100%
Operational/Managerial Control Oct 1, 2016 100%

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 995

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 995

NPI Registry JSON

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

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1033664909",
    "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": "864-455-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "SUITE C300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH-UPSTATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-22",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "VP PAYOR STRATEGIES & ALIGNMENT",
        "authorized_official_telephone_number": "864-522-2286"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "SC",
            "license": "HTL-0933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prisma Health Vascular Health Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.