Active NPI
Andrea Gina Joaquim, PA-C
- Physician Assistant
- Greenville, SC
National Provider Identifier
1043970056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 4281
- Practice address
- 200 Patewood Dr Ste B260
Greenville, SC 29615-6328 - Phone
- (864) 454-2852
- Fax
- (864) 454-2899
- NPI assigned
- Dec 19, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | |||
| Surgical Physician Assistant | 363AS0400X | |||
| Physician Assistant | 363A00000X | 4281 | SC | Primary |
Addresses
Primary practice location
200 Patewood Dr Ste B260
Greenville, SC 29615-6328
Mailing address
300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603
Other practice location 1
890 W Faris Rd Ste 310
Greenville, SC 29605-4281
Phone (864) 455-8300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5115PA | Medicaid | SC |
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: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220427000628 | SC | Practitioner - Physician Assistant | 0648667386 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
200 Patewood Dr
Suite C300
Greenville, SC 29615-6324
Phone (864) 454-8272
210 Freeman Farm Rd
Duncan, SC 29334-9398
Phone (864) 968-5123
Hospital & facility affiliations
- Interim Healthcare of the Upstate
- Prisma Health Patewood Hospital
- St Francis-Downtown
- Prisma Health Greer Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4281 | SC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prisma Health University Medical Group | Current | Accepting new patients | |
| Prisma Health University Medical Group | Current | Accepting new patients | |
| Prisma Health University Medical Group | Past | Accepting new patients |
Locations
210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123
300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615
890 W Faris Rd
Ste 310
Greenville, SC 29605
Phone (864) 455-8300
2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761
100 Omni Dr
#B
Seneca, SC 29672
Phone (864) 482-2350
Interoperability endpoints
- ajoaquim574654@direct.ghs.myhfn.org
Organizations & group practices 3
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.
-
- Gynecology Physician
- Greer, SC
- NPI 1003619313
-
- Pediatrics Physician
- Taylors, SC
- NPI 1801524392
Hospital & facility affiliations 16
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Greenville, SC
- NPI 1750897609
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683849600000",
"number": "1043970056",
"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": "864-522-8603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 PATEWOOD DR STE B260",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296156328",
"telephone_number": "864-454-2852",
"fax_number": "864-454-2899"
}
],
"practiceLocations": [
{
"address_1": "890 W Faris Rd Ste 310",
"address_purpose": "LOCATION",
"city": "Greenville",
"state": "SC",
"postal_code": "296054281",
"country_code": "US",
"telephone_number": "864-455-8300",
"fax_number": "864-455-8310",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOAQUIM",
"first_name": "ANDREA",
"middle_name": "GINA",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-19",
"last_updated": "2023-05-12",
"certification_date": "2023-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "4281",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5115PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.