Organization Active NPI

Palmetto Internal Medicine & Primary Care, PA

  • Internal Medicine Physician
  • Mauldin, SC
National Provider Identifier
1124335898
Registry record updated Nov 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
19652 Issued in SC
Legal business name
PALMETTO INTERNAL MEDICINE & PRIMARY CARE, PA
Practice address
300 W Butler Rd
Mauldin, SC 29662-2538
Phone
(864) 277-8300
Fax
(864) 288-8722
NPI assigned
Sep 1, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2012

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

Authorized official

Name
Bala Krishniah, MD
Title
Physician Owner
Phone
(864) 991-9015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 19652 SC Primary

Addresses

Primary practice location

300 W Butler Rd
Mauldin, SC 29662-2538

Mailing address

300 W Butler Rd
Mauldin, SC 29662-2538
Phone (864) 277-8300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110224000223 SC Part B Supplier - Clinic/Group Practice 7719168723 Receives reassigned benefits from 13 practitioners
Practice locations: Mauldin, 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
42D2013664Palmetto Internal Medicine & Primary Care PA300 West Butler Road, Mauldin, SC 29662Provider-performed microscopySep 22, 2026

National Provider Directory

National Provider Directory

Locations

545 W Butler Rd
#A
Greenville, SC 29607
Phone (864) 236-9555

511 W Butler Rd
#A
Greenville, SC 29607
Phone (864) 277-8300

300 W Butler Rd
Mauldin, SC 29662
Phone (864) 277-8300

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352764800000",
    "number": "1124335898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W BUTLER RD",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622538",
            "telephone_number": "864-277-8300",
            "fax_number": "864-288-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W BUTLER RD",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622538",
            "telephone_number": "864-277-8300",
            "fax_number": "864-288-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO INTERNAL MEDICINE & PRIMARY CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-01",
        "last_updated": "2012-11-13",
        "status": "A",
        "authorized_official_last_name": "KRISHNIAH",
        "authorized_official_first_name": "BALA",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "864-991-9015",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "19652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mauldin, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; 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.