NPIMap

Organization Active NPI

Gross Family Practice LLC

  • Rural Health Clinic/Center
  • Orangeburg, SC
National Provider Identifier
1083961114
Registry record updated Sep 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GROSS FAMILY PRACTICE LLC
Practice address
970 Holly St
Orangeburg, SC 29115-4930
Phone
(803) 531-2722
Fax
(803) 531-2743
NPI assigned
Aug 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2012

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

Authorized official

Name
Verdell F Haygood
Title
Office Manager
Phone
(803) 531-2722

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 0646 SC
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

970 Holly St
Orangeburg, SC 29115-4930

Mailing address

970 Holly St
Orangeburg, SC 29115-4930
Phone (803) 531-2722

Other identifiers 2

IdentifierTypeStateIssuer
H410155677OtherSCMEDICARE ID
T00617MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Gross Family Practice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IGJDBA

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348185600000",
    "number": "1083961114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 HOLLY ST",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154930",
            "telephone_number": "803-531-2722",
            "fax_number": "803-531-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 HOLLY ST",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154930",
            "telephone_number": "803-531-2722",
            "fax_number": "803-531-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROSS FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-08",
        "last_updated": "2012-09-21",
        "status": "A",
        "authorized_official_last_name": "HAYGOOD",
        "authorized_official_first_name": "VERDELL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-531-2722"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "0646",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "H410155677",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T00617",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2012; 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.