NPIMap

Individual provider Active NPI

Tiffany Amber Riley, PA-C

  • Physician Assistant
  • Greenville, SC
National Provider Identifier
1154738094
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3215 Issued in SC
Practice address
1005 Grove Rd FL 4
Greenville, SC 29605-4630
Phone
(864) 455-6900
Fax
(864) 255-5619
NPI assigned
Jul 11, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3215 SC Primary
Physician Assistant 363A00000X PA9108032 FL
Physician Assistant 363A00000X 14722 MN

Addresses

Primary practice location

1005 Grove Rd FL 4
Greenville, SC 29605-4630

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842

Other practice location 1

400 E 3rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Other identifiers 1

IdentifierTypeStateIssuer
012656500MedicaidFL

Other names 1

  • Tiffany Hattendorf Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, SC, MN3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140815001509 FL Practitioner - Physician Assistant 1355568270 Reassigns benefits to 1 organization
I20191017002107 SC Practitioner - Physician Assistant 1355568270 Reassigns benefits to 1 organization
I20240410000408 MN Practitioner - Physician Assistant 1355568270 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical CenterGroup PAC ID 6901706357, 91 clinicians

Practice addresses (Care Compare)

1005 Grove Rd
Greenville, SC 29605-4630
Phone (864) 455-6900

200 Patewood Dr
Suite B480
Greenville, SC 29615-6327
Phone (864) 454-4570

210 Freeman Farm Rd
Duncan, SC 29334-9398
Phone (864) 968-5123

300 E McBee Ave
Greenville, SC 29601-2842
Phone (864) 797-6220

300 E McBee Ave FL
Suite 4
Greenville, SC 29601-2842

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-3443

717 SE Main St
Simpsonville, SC 29681-3237
Phone (864) 522-5400

719 A SE Main St
Simpsonville, SC 29681-3237
Phone (864) 967-9000

719 SE Main St
Simpsonville, SC 29681-3237
Phone (864) 522-5400

741 SE Main St
Simpsonville, SC 29681-3237
Phone (864) 522-8420

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
14722MNMDMusic Therapist
3215SCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Jul 25, 2014 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jul 25, 2014 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Mar 25, 2024 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic LTD CurrentSince Mar 25, 2024 Accepting new patients
Prisma Health University Medical Group CurrentSince Oct 7, 2019 Accepting new patients
Prisma Health University Medical Group CurrentSince Oct 7, 2019 Accepting new patients
St. Mary's Medical Center CurrentSince Oct 1, 2024 Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients
Prisma Health University Medical Group Past Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1505 SW Archer Rd
Gainesville, FL 32608
Phone (352) 265-5470

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

4855 W Arrowhead Rd
Hermantown, MN 55811
Phone (218) 786-3540

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

877 W Faris Rd
Ste B
Greenville, SC 29605
Phone (864) 522-6225

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

1005 Grove Rd
Greenville, SC 29605
Phone (864) 235-7665

1005 Grove Rd
Fl 4
Greenville, SC 29605

200 Patewood Dr
Ste B480
Greenville, SC 29615
Phone (864) 454-4200

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

727 SE Main St
Ste 100
Simpsonville, SC 29681
Phone (864) 454-6520

Interoperability endpoints

  • Direct secure messaging: thattendorf267721@direct.ghs.myhfn.org

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 50

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1154738094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 GROVE RD FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054630",
            "telephone_number": "864-455-6900",
            "fax_number": "864-255-5619"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 E 3rd St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558051951",
            "country_code": "US",
            "telephone_number": "218-786-8364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "TIFFANY",
        "middle_name": "AMBER",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-11",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3215",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108032",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14722",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012656500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "HATTENDORF",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.