Active NPI
Vincent Colucciello
- Psychiatry Physician
- Greer, SC
National Provider Identifier
1174374995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- LL92663
- Practice address
- 109 Physicians Dr
Greer, SC 29650-2446 - Phone
- (864) 797-9170
- NPI assigned
- Mar 29, 2024
- Last updated
- Jul 16, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | LL92663 | SC | Primary |
Addresses
Primary practice location
109 Physicians Dr
Greer, SC 29650-2446
Mailing address
109 Physicians Dr
Greer, SC 29650-2446
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL92663 | SC | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721088000000",
"number": "1174374995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 PHYSICIANS DR",
"city": "GREER",
"state": "SC",
"postal_code": "296502446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 PHYSICIANS DR",
"city": "GREER",
"state": "SC",
"postal_code": "296502446",
"telephone_number": "864-797-9170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLUCCIELLO",
"first_name": "VINCENT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-29",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "SC",
"license": "LL92663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greer, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.