NPIMap

Individual provider Active NPI

Anthony Petruso, MD

  • Internal Medicine Physician
  • Greenville, SC
National Provider Identifier
1174847800
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
87497 Issued in SC
Practice address
1 E Stone Ave
Greenville, SC 29609-5619
Phone
(864) 522-6500
Fax
(864) 522-6505
NPI assigned
Mar 24, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 266779 NY
Pediatrics Physician 208000000X 87497 SC
Internal Medicine Physician 207R00000X 87497 SC Primary

Addresses

Primary practice location

1 E Stone Ave
Greenville, SC 29609-5619

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

224 Alexander St Ste 4000
Rochester, NY 14607-4000
Phone (585) 922-8070

Other practice location 2

1809 Wade Hampton Blvd Ste 120
Greenville, SC 29609-4050
Phone (864) 522-5000

Other identifiers 2

IdentifierTypeStateIssuer
03887198MedicaidNY
874977MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220909001270 SC Practitioner - Internal MedicinePractitioner - Pediatric Medicine 6800013640 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Ohio State University College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prisma Health Urgent Care of South Carolina PCGroup PAC ID 1254703788, 158 clinicians

Practice addresses (Care Compare)

1305 S Suber Rd
Greer, SC 29650-0944
Phone (864) 989-4609

1809 Wade Hampton Blvd
Suite 120
Greenville, SC 29609-4050
Phone (864) 522-5000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Urgent Care of South Carolina, PC CurrentSince Feb 7, 2023 Accepting new patients
Prisma Health University Medical Group CurrentSince Aug 22, 2022 Accepting new patients
Prisma Health University Medical Group Internal Medicine CurrentSince Aug 22, 2022 Accepting new patients

Locations

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

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

1 E Stone Ave
Greenville, SC 29609
Phone (864) 235-9115

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

1809 Wade Hampton Blvd
Ste 120
Greenville, SC 29609
Phone (864) 322-4665

1305 S Suber Rd
Greer, SC 29650
Phone (864) 989-4609

Interoperability endpoints

  • Direct secure messaging: apetruso602179@direct.ghs.myhfn.org

Organizations & group practices 3

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

Hospital & facility affiliations 63

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

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710374400000",
    "number": "1174847800",
    "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",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E STONE AVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296095619",
            "telephone_number": "864-522-6500",
            "fax_number": "864-522-6505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "224 Alexander St Ste 4000",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146074000",
            "country_code": "US",
            "telephone_number": "585-922-8070",
            "fax_number": "585-922-8078",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1809 Wade Hampton Blvd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296094050",
            "country_code": "US",
            "telephone_number": "864-522-5000",
            "fax_number": "864-241-9275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRUSO",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-24",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "266779",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "87497",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "87497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03887198",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "874977",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.