NPIMap

Organization Active NPI

Carolina Physical Medicine and

Doing business as CORE Health Centers-East Spartanburg

  • General Practice Physician
  • Spartanburg, SC
National Provider Identifier
1124342506
Registry record updated Jun 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CAROLINA PHYSICAL MEDICINE AND
Doing business as
CORE Health Centers-East Spartanburg
Practice address
958 E Main St
Suite a
Spartanburg, SC 29302-2148
Phone
(864) 542-0780
Fax
(864) 542-1689
NPI assigned
Mar 15, 2010
Last updated
Jun 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2015

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

Authorized official

Name
Stephanie C Waddell, CPC
Title
Billing Manager
Phone
(864) 469-2045

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Chiropractor 111N00000X NU
Family Medicine Physician 207Q00000X NU
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

958 E Main St
Suite a
Spartanburg, SC 29302-2148

Mailing address

958 E Main St
Suite a
Spartanburg, SC 29302-2148
Phone (864) 542-0780

Other identifiers 1

IdentifierTypeStateIssuer
193200000XOtherSCTAXONOMY CODE

Other names 1

  • CORE Health Centers-East Spartanburg Doing business as

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

958 E Main St
#A
Spartanburg, SC 29302
Phone (864) 542-0780

Practitioners & affiliated clinicians

Practitioners 7

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": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434412800000",
    "number": "1124342506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "958 E MAIN ST",
            "address_2": "SUITE A",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293022148",
            "telephone_number": "864-542-0780",
            "fax_number": "864-542-1689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 E MAIN ST",
            "address_2": "SUITE A",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293022148",
            "telephone_number": "864-542-0780",
            "fax_number": "864-542-1689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA PHYSICAL MEDICINE AND",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2015-06-16",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "864-469-2045",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY CODE",
            "identifier": "193200000X",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORE Health Centers-East Spartanburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 16, 2015; 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.