NPIMap

Organization Active NPI

Palmetto Wellness & Injury Center of Bennettsville LLC

  • Family Medicine Physician
  • Bennettsville, SC
National Provider Identifier
1124240999
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
23493 Issued in SC
Legal business name
PALMETTO WELLNESS & INJURY CENTER OF BENNETTSVILLE LLC
Practice address
102 Lindsay Ave
Bennettsville, SC 29512-3102
Phone
(843) 479-6102
Fax
(843) 479-6103
NPI assigned
May 2, 2007
Last updated
Mar 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Authorized official

Name
Dr. Raymond H Stroup, D.C.NPI 1528032554
Title
President
Phone
(843) 479-6102

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2688 SC
Family Medicine Physician 207Q00000X 23493 SC Primary
Family Medicine Physician 207Q00000X 29388 SC

Addresses

Primary practice location

102 Lindsay Ave
Bennettsville, SC 29512-3102

Mailing address

102 Lindsay Ave
PO Box 432
Bennettsville, SC 29512-3102
Phone (843) 479-6102

Other identifiers 1

IdentifierTypeStateIssuer
CH2668MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070823000010 SC Part B Supplier - Clinic/Group Practice 6305938267 Receives reassigned benefits from 3 practitioners
Practice locations: Bennettsville, SC; Cheraw, SC

National Provider Directory

National Provider Directory

Locations

102 Lindsay Ave
Bennettsville, SC 29512
Phone (843) 454-0026

1021 Cheraw St
Bennettsville, SC 29512
Phone (843) 454-9000

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1124240999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 LINDSAY AVE",
            "address_2": "PO BOX 432",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295123102",
            "telephone_number": "843-479-6102",
            "fax_number": "843-479-6103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 LINDSAY AVE",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295123102",
            "telephone_number": "843-479-6102",
            "fax_number": "843-479-6103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO WELLNESS & INJURY CENTER OF BENNETTSVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "STROUP",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-479-6102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "2688",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "23493",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "29388",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH2668",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennettsville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; 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.