NPIMap

Individual provider Active NPI

Theodore Matthew Eison, MD

  • Pediatric Nephrology Physician
  • Greenville, SC
National Provider Identifier
1184773582
Registry record updated Mar 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
35122 Issued in SC
Practice address
200 Patewood Dr Ste A115
Greenville, SC 29615-3547
Phone
(864) 454-5105
Fax
(864) 454-5689
NPI assigned
Jan 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nephrology Physician 2080P0210X 42534 TN
Pediatric Nephrology Physician 2080P0210X 35122 SC Primary

Addresses

Primary practice location

200 Patewood Dr Ste A115
Greenville, SC 29615-3547

Mailing address

1 Independence PT Ste 212
Greenville, SC 29615-4536

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
I20121119000563 SC Practitioner - Pediatric Medicine 2567459027 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Medical University of South Carolina College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health University Medical Group 2,467 clinicians

Practice addresses (Care Compare)

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35122SCMDPediatric Nephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greenville Health System CurrentSince Oct 1, 2012 Accepting new patients
Prisma Health University Medical Group CurrentSince Oct 1, 2012 Accepting new patients
Greenville Health System Current Accepting new patients
Prisma Health University Medical Group CurrentSince Oct 1, 2012 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Ut Lebonheur Pediatric Specialists, Inc. Pediatric Nephrology Past Accepting new patients

Locations

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

200 Patewood Dr
Bldg A
Greenville, SC 29615
Phone (864) 454-2604

200 Patewood Dr
Ste A115
Greenville, SC 29615
Phone (864) 454-5105

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

100 Augusta St
Greenville, SC 29601
Phone (864) 455-2600

315 Medical Pkwy
Ste 200
Greer, SC 29650
Phone (864) 797-9550

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

807 N Main St
Travelers Rst, SC 29690
Phone (864) 834-5132

Interoperability endpoints

  • Direct secure messaging: teison7287@direct.ghs.myhfn.org

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521676800000",
    "number": "1184773582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT STE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR STE A115",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153547",
            "telephone_number": "864-454-5105",
            "fax_number": "864-454-5689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISON",
        "first_name": "THEODORE",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2018-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "TN",
            "license": "42534",
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "SC",
            "license": "35122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.