Organization Active NPI

Bevid Medical

  • Family Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1104522846
Registry record updated Dec 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BEVID MEDICAL
Practice address
324 N Pine St Ste a
Spartanburg, SC 29302-1631
Phone
(864) 485-3070
NPI assigned
Feb 3, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2023

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

Authorized official

Name
Dr. Omar G DanielsNPI 1629768049
Title
Ceo
Phone
(864) 266-3176

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

324 N Pine St Ste a
Spartanburg, SC 29302-1631

Mailing address

584 Verdae Dr
Spartanburg, SC 29301-5384
Phone (864) 266-3176

Other practice location 1

2086 Woodruff Rd Ste B
Greenville, SC 29607-5939
Phone (864) 652-3010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230703001892 SC Part B Supplier - Clinic/Group Practice 7810356227 Receives reassigned benefits from 7 practitioners
Practice locations: Spartanburg, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2284339Bevid Medical LLC324 N Pine Street, Suite a, Spartanburg, SC 29302Certificate of waiverJun 20, 2027

National Provider Directory

National Provider Directory

Locations

2086 Woodruff Rd
#B
Greenville, SC 29607
Phone (864) 329-9526

324 N Pine St
#A
Spartanburg, SC 29302
Phone (305) 901-5055

324 N Pine St
Spartanburg, SC 29302
Phone (864) 580-7010

Practitioners & affiliated clinicians

Practitioners 8

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": "1675382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703980800000",
    "number": "1104522846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "584 VERDAE DR",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293015384",
            "telephone_number": "864-266-3176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 N PINE ST STE A",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293021631",
            "telephone_number": "864-485-3070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2086 Woodruff Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296075939",
            "country_code": "US",
            "telephone_number": "864-652-3010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEVID MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-03",
        "last_updated": "2023-12-31",
        "certification_date": "2023-12-31",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "OMAR",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "864-266-3176",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.