NPIMap

Individual provider Active NPI

Edward Benjamin Penn Jr., MD

  • Otolaryngology Physician
  • Greenville, SC
National Provider Identifier
1053474163
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
51723 Issued in SC
Practice address
200 Patewood Dr Ste B400
Greenville, SC 29615-6306
Phone
(864) 522-8603
NPI assigned
Dec 19, 2006
Last updated
Sep 16, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Otolaryngology Physician 207YP0228X 51723 SC
Otolaryngology Physician 207Y00000X 51723 SC Primary

Addresses

Primary practice location

200 Patewood Dr Ste B400
Greenville, SC 29615-6306

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

105 Carter Park Dr Ste B
Seneca, SC 29678-1152
Phone (864) 482-3122

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171227000004 SC Practitioner - Otolaryngology 3971759416 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Kansas School of Med (KC/Wich/Sal), 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Patewood Dr
Suite B400
Greenville, SC 29615-6306
Phone (864) 454-4368

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.33 of 100Reported as group
Quality
75.48
Promoting interoperability
100
Improvement activities
40
Cost
72.29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51723SCMDPediatric Otolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Nov 20, 2017 Accepting new patients
Prisma Health University Medical Group CurrentSince Nov 20, 2017 Accepting new patients

Locations

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

1 Doctors Dr
Greenville, SC 29605
Phone (864) 271-3354

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

200 Patewood Dr
Ste B400
Greenville, SC 29615
Phone (864) 454-4368

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

325 Medical Pkwy
Ste 250
Greer, SC 29650
Phone (864) 797-9080

105 Carter Park Dr
Ste B
Seneca, SC 29678
Phone (864) 482-3122

Interoperability endpoints

  • Direct secure messaging: epenn178097@direct.ghs.myhfn.org

Organizations & group practices 2

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

Hospital & facility affiliations 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789516800000",
    "number": "1053474163",
    "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 B400",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156306",
            "telephone_number": "864-522-8603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Carter Park Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Seneca",
            "state": "SC",
            "postal_code": "296781152",
            "country_code": "US",
            "telephone_number": "864-482-3122",
            "fax_number": "864-482-3152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENN",
        "first_name": "EDWARD",
        "middle_name": "BENJAMIN",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "SC",
            "license": "51723",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "SC",
            "license": "51723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.