NPIMap

Organization Active NPI

Vitalen Inpatient Care PC

  • Hospitalist Physician
  • Greenville, SC
National Provider Identifier
1083217616
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
VITALEN INPATIENT CARE PC
Practice address
1 Saint Francis Dr
Greenville, SC 29601-3955
Phone
(864) 255-1000
NPI assigned
Nov 17, 2020
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Theophile Koury
Title
President
Phone
(510) 851-7411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X NU Primary

Addresses

Primary practice location

1 Saint Francis Dr
Greenville, SC 29601-3955

Mailing address

2100 Powell St Ste 400
Emeryville, CA 94608-1826
Phone (510) 851-7411

Other practice location 1

125 Commonwealth Dr
Greenville, SC 29615-4812
Phone (864) 675-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210125001276 SC Part B Supplier - Clinic/Group Practice 6901210418 Receives reassigned benefits from 85 practitioners
1 other NPI on this enrollment
Practice locations: Greenville, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 85

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 85

NPI Registry JSON

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1083217616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST STE 400",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081826",
            "telephone_number": "510-851-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SAINT FRANCIS DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296013955",
            "telephone_number": "864-255-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Commonwealth Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296154812",
            "country_code": "US",
            "telephone_number": "864-675-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITALEN INPATIENT CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "KOURY",
        "authorized_official_first_name": "THEOPHILE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-851-7411"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "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 Dec 22, 2020; 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.