NPIMap

Individual provider Active NPI

Robert Clifton Timmerman Jr., MD

  • Anesthesiology Physician
  • Greenville, SC
National Provider Identifier
1205003001
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
37880 Issued in SC
Practice address
67 Creekside Park CT
Greenville, SC 29615-4810
Phone
(864) 242-4602
Fax
(864) 242-0129
NPI assigned
May 12, 2008
Last updated
Mar 4, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X ME113040 FL
Anesthesiology Physician 207L00000X 37880 SC Primary
Surgery Physician 208600000X TRN12469 FL

Addresses

Primary practice location

67 Creekside Park CT
Greenville, SC 29615-4810

Mailing address

1 Independence PT
Suite 212
Greenville, SC 29615-4545
Phone (864) 797-6044

Other identifiers 2

IdentifierTypeStateIssuer
378807MedicaidSC
005946200MedicaidFL

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
I20150812009101 SC Practitioner - Anesthesiology 3971768870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of South Carolina School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

67 Creekside Park CT
Greenville, SC 29615-4810
Phone (864) 522-3700

701 Grove Rd
Greenville, SC 29605-4210

830 S Buncombe Rd
Greer, SC 29650-2400
Phone (864) 455-2455

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN12469FLMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Jul 20, 2015 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Prisma Health University Medical Group Anesthesiology CurrentSince Jul 20, 2015 Accepting new patients

Locations

22725 US Highway 76
Clinton, SC 29325
Phone (864) 833-9100

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

67 Creekside Park Ct
Greenville, SC 29615
Phone (864) 242-4602

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

298 Memorial Dr
Seneca, SC 29672
Phone (864) 482-3100

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: rtimmerman33596@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 47

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

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457049600000",
    "number": "1205003001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT",
            "address_2": "SUITE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154545",
            "telephone_number": "864-797-6044",
            "fax_number": "864-797-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 CREEKSIDE PARK CT",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154810",
            "telephone_number": "864-242-4602",
            "fax_number": "864-242-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMMERMAN",
        "first_name": "ROBERT",
        "middle_name": "CLIFTON",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-12",
        "last_updated": "2016-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME113040",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "37880",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "TRN12469",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "378807",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005946200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.