NPIMap

Organization Active NPI

Superior Healthcare Physical Medicine of Greenville Inc

  • Physical Medicine & Rehabilitation Physician
  • Greenville, SC
National Provider Identifier
1194195941
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SUPERIOR HEALTHCARE PHYSICAL MEDICINE OF GREENVILLE INC
Practice address
2520 Wade Hampton Blvd Ste B
Greenville, SC 29615-1178
Phone
(864) 558-8174
NPI assigned
Oct 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Authorized official

Name
Jeremy Wilson
Title
Owner
Phone
(864) 404-0433

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X SC

Addresses

Primary practice location

2520 Wade Hampton Blvd Ste B
Greenville, SC 29615-1178

Mailing address

2520 Wade Hampton Blvd Ste B
Greenville, SC 29615-1178
Phone (864) 558-8174

Other practice location 1

3223A N Pleasantburg Dr
Greenville, SC 29609-2900
Phone (864) 404-0433

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151228001380 SC Part B Supplier - Clinic/Group Practice 3274834874 Receives reassigned benefits from 5 practitioners
Practice locations: Greenville, SC
O20160520002093 SC DME Supplier - Physician - General Practice 3274834874 Practice locations: Greenville, SC

National Provider Directory

National Provider Directory

Locations

3223 N Pleasantburg Dr
Greenville, SC 29609
Phone (864) 558-8174

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1444003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1194195941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 WADE HAMPTON BLVD STE B",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296151178",
            "telephone_number": "864-558-8174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 WADE HAMPTON BLVD STE B",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296151178",
            "telephone_number": "864-558-8174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3223A N Pleasantburg Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296092900",
            "country_code": "US",
            "telephone_number": "864-404-0433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUPERIOR HEALTHCARE PHYSICAL MEDICINE OF GREENVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-05",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-404-0433"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.