NPIMap

Organization Active NPI

Southern Eye Associates of South Carolina, PA

  • Ophthalmology Physician
  • Greenville, SC
National Provider Identifier
1215933510
Registry record updated Apr 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA
Practice address
113 Doctors Dr
Greenville, SC 29605-5608
Phone
(864) 269-3333
Fax
(864) 295-1288
NPI assigned
Jun 22, 2005
Last updated
Apr 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2018

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

Authorized official

Name
Barbara Renee Bailey
Title
Practice Manager
Phone
(642) 220-0737

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

113 Doctors Dr
Greenville, SC 29605-5608

Mailing address

113 Doctors Dr
Greenville, SC 29605-5608
Phone (864) 269-3333

Other identifiers 21

IdentifierTypeStateIssuer
1821439878OtherSCNPI
GP2766MedicaidSC
1295886125OtherSCNPI
1396841599OtherSCNPI
335998MedicaidSC
D17998MedicaidSC
1053369777OtherSCNPI
1571OtherSCMEDICARE GROUP GREENVILLE OFFICE NUMBER
1639127046OtherSCNPI
T48026MedicaidSC
1548218340OtherSCNPI
52668MedicaidSC
TL5190MedicaidSC
130735MedicaidSC
DA9608MedicaidSC
PA6449MedicaidSC
1205122975OtherMONPI
1760431035OtherSCNPI
1437107836OtherSCNPI
153549MedicaidSC
6180OtherSCMEDICARE GROUP NUMBER GREER OFFICE

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041220000527 SC Part B Supplier - Clinic/Group Practice 4183681356 Receives reassigned benefits from 19 practitioners
2 other NPIs on this enrollment
Practice locations: Clemson, SC; Greenville, SC; Greer, SC; Simpsonville, SC
O20100930032351 SC DME Supplier - Physician - Ophthalmology 4183681356 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, SC

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524182400000",
    "number": "1215933510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 DOCTORS DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296055608",
            "telephone_number": "864-269-3333",
            "fax_number": "864-295-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 DOCTORS DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296055608",
            "telephone_number": "864-269-3333",
            "fax_number": "864-295-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN EYE ASSOCIATES OF SOUTH CAROLINA, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2018-04-20",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "642-220-0737"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1821439878",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2766",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1295886125",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1396841599",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "335998",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D17998",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1053369777",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP GREENVILLE OFFICE NUMBER",
            "identifier": "1571",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639127046",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T48026",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548218340",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52668",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TL5190",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130735",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9608",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA6449",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1205122975",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1760431035",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1437107836",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153549",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER GREER OFFICE",
            "identifier": "6180",
            "state": "SC"
        }
    ],
    "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 Apr 20, 2018; 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.