NPIMap

Organization Active NPI

Prisma Health University Medical Group

Doing business as University Medical Group/Mobile Health Clinic

  • Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1053786483
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Doing business as
University Medical Group/Mobile Health Clinic
Practice address
712 Grove Rd
Greenville, SC 29605-4211
Phone
(864) 455-9349
Fax
(864) 522-1428
NPI assigned
Dec 10, 2015
Last updated
Jun 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Authorized official

Name
Kristi Ann Lawrence
Title
Director Provider Enrollment
Phone
(864) 385-4790

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X

Addresses

Primary practice location

712 Grove Rd
Greenville, SC 29605-4211

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 385-4790

Other names 1

  • University Medical Group/Mobile Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000238 SC Part B Supplier - Clinic/Group Practice 8325950983 Receives reassigned benefits from 3,477 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
GHS Partners in Health34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Locations

10 Patewood Dr
Ste 130
Greenville, SC 29615
Phone (864) 455-8988

1011 Frontage Rd
Greenville, SC 29615
Phone (864) 242-4263

11402 Anderson Rd
Ste A
Greenville, SC 29611
Phone (864) 631-2799

200 Patewood Dr
Ste A140
Greenville, SC 29615
Phone (864) 454-5125

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

48 Centennial Way
Greenville, SC 29605
Phone (864) 522-8000

67 Creekside Park Ct
Greenville, SC 29615
Phone (864) 242-4602

890 S Pleasantburg Dr
Greenville, SC 29607
Phone (864) 271-1450

405 Memorial Drive Ext
Greer, SC 29651
Phone (864) 334-0141

100 Omni Dr
#A
Seneca, SC 29672
Phone (864) 885-7520

1336 Highway 14
Simpsonville, SC 29681
Phone (864) 522-4705

201 E Broad St
Spartanburg, SC 29306
Phone (864) 707-2135

9 McElhaney Rd
Travelers Rst, SC 29690
Phone (864) 834-3192

Practitioners & affiliated clinicians

Practitioners 325

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.

View all 325

NPI Registry JSON

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750723200000",
    "number": "1053786483",
    "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": "864-385-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054211",
            "telephone_number": "864-455-9349",
            "fax_number": "864-522-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH UNIVERSITY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-10",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "864-385-4790"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Medical Group/Mobile Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University Medical Group/Mobile Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.