Individual provider Active NPI

Walter Tennyson Jamison

  • In Home Supportive Care Agency
  • Greenville, SC
National Provider Identifier
1053892679
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
IHCP-0858 Issued in SC
Practice address
500 Mills Ave Ste C
Greenville, SC 29605-4280
Phone
(864) 214-3794
Fax
(864) 233-8626
NPI assigned
Aug 22, 2018
Last updated
Aug 22, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X IHCP-0858 SC Primary

Addresses

Primary practice location

500 Mills Ave Ste C
Greenville, SC 29605-4280

Mailing address

500 Mills Ave Ste C
Greenville, SC 29605-4280
Phone (864) 214-3794

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
IHCP-0858SCMDIn Home Supportive Care Agency

Practice roles

OrganizationSpecialtyStatusNew patients
In-Home Assisted Living In Home Supportive Care CurrentSince Jan 28, 2024 Accepting new patients
Certified Caregivers-Spartanburg In Home Supportive Care Current Accepting new patients

Locations

500 Mills Ave
Ste C
Greenville, SC 29605
Phone (864) 214-3794

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.

NPI Registry JSON

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1053892679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MILLS AVE STE C",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054280",
            "telephone_number": "864-214-3794",
            "fax_number": "864-233-8626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MILLS AVE STE C",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054280",
            "telephone_number": "864-214-3794",
            "fax_number": "864-233-8626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAMISON",
        "first_name": "WALTER",
        "middle_name": "TENNYSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-22",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "SC",
            "license": "IHCP-0858",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.