NPIMap

Organization Active NPI

Spartanburg Ear Nose & Throat, Head & Neck Surgery PA

  • Specialist
  • Spartanburg, SC
National Provider Identifier
1225082019
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SPARTANBURG EAR NOSE & THROAT, HEAD & NECK SURGERY PA
Practice address
1095 Iron Ore Road
Spartanburg, SC 29303-2239
Phone
(864) 582-2900
Fax
(864) 582-4991
NPI assigned
May 19, 2006
Last updated
Oct 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Authorized official

Name
Mrs. Allison Rodgers
Title
Human Resources
Phone
(864) 582-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

1095 Iron Ore Road
Spartanburg, SC 29303-2239

Mailing address

P.O. Box 5787
Spartanburg, SC 29304-5787
Phone (864) 582-2900

Other identifiers 2

IdentifierTypeStateIssuer
CB3406OtherSCRAILROAD MEDICARE
PA0828MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040625000295 SC Part B Supplier - Clinic/Group Practice 6608852165 Receives reassigned benefits from 16 practitioners
1 other NPI on this enrollment
Practice locations: Greer, SC; Spartanburg, SC

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2038266Spartanburg Ear, Nose & Throat1095 Iron Ore Road, Spartanburg, SC 29303Certificate of waiverMar 15, 2028

National Provider Directory

National Provider Directory

Locations

2755 S Highway 14
Ste 2400
Greer, SC 29650
Phone (864) 582-2900

1330 Boiling Springs Rd
Ste 1400
Spartanburg, SC 29303
Phone (864) 278-1442

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": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1225082019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5787",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293045787",
            "telephone_number": "864-582-2900",
            "fax_number": "864-582-4991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 IRON ORE ROAD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293032239",
            "telephone_number": "864-582-2900",
            "fax_number": "864-582-4991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG EAR NOSE & THROAT, HEAD & NECK SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "864-582-2900",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB3406",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA0828",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.