NPIMap

Organization Active NPI

Anesthesiology Services of Anderson, PA

  • Anesthesiology Physician
  • Anderson, SC
National Provider Identifier
1174513824
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
13681 Issued in SC
Legal business name
ANESTHESIOLOGY SERVICES OF ANDERSON, PA
Practice address
800 N Fant St
Anderson, SC 29621-5708
Phone
(864) 431-1958
NPI assigned
Oct 25, 2005
Last updated
Dec 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Authorized official

Name
Matthew Patrick Elliott, MDNPI 1700020054
Title
President
Phone
(864) 431-1958

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 13681 SC Primary

Addresses

Primary practice location

800 N Fant St
Anderson, SC 29621-5708

Mailing address

PO Box 1657
Anderson, SC 29622-1657
Phone (864) 431-1958

Other identifiers 7

IdentifierTypeStateIssuer
057002MedicaidSC
080959MedicaidSC
269701MedicaidSC
144560MedicaidSC
077446MedicaidSC
GP1396MedicaidSC
TL4288MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040721000892 SC Part B Supplier - Clinic/Group Practice 7517947526 Receives reassigned benefits from 32 practitioners
Practice locations: Anderson, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 55

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.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1174513824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1657",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296221657",
            "telephone_number": "864-431-1958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N FANT ST",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296215708",
            "telephone_number": "864-431-1958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANESTHESIOLOGY SERVICES OF ANDERSON, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-25",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-431-1958",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "13681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "057002",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080959",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269701",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144560",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "077446",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1396",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TL4288",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.