NPIMap

Individual provider Active NPI

Kevin Shultz, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Greer, SC
National Provider Identifier
1083900724
Registry record updated Feb 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
52489 Issued in SC
Practice address
301 The Pkwy
Greer, SC 29650-5221
Phone
(649) 680-1688
Fax
(864) 968-9248
NPI assigned
Jun 21, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 52489 SC Primary

Addresses

Primary practice location

301 The Pkwy
Greer, SC 29650-5221

Mailing address

301 The Pkwy
Greer, SC 29650-5221
Phone (864) 968-0168

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
I20181002000990 SC Practitioner - Plastic and Reconstructive Surgery 0840570925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Texas a & M University System, HSC, College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upstate Plastic SurgeryGroup PAC ID 0840103263, 4 clinicians

Practice addresses (Care Compare)

301 The Pkwy
Suite a
Greer, SC 29650-5221
Phone (864) 968-0168

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy17
Melanoma (skin cancer) excision13
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52489SCMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Plastic Surgery CurrentSince Jul 31, 2018 Accepting new patients

Locations

301 The Pkwy
Ste A
Greer, SC 29650
Phone (864) 968-0168

301 The Pkwy
Greer, SC 29650
Phone (864) 657-5156

Interoperability endpoints

  • Direct secure messaging: kshultz@directaddress.net

Organizations & group practices 1

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 11

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

NPI Registry JSON

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548979200000",
    "number": "1083900724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 THE PKWY",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296505221",
            "telephone_number": "864-968-0168",
            "fax_number": "864-968-9248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 THE PKWY",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296505221",
            "telephone_number": "649-680-1688",
            "fax_number": "864-968-9248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULTZ",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-21",
        "last_updated": "2019-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "SC",
            "license": "52489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greer, SC

Sources for this page

Verify at the official NPI Registry.