NPIMap

Organization Active NPI

Greenwood Genetics Center, Inc.

  • Clinical Genetics (M.D.) Physician
  • Columbia, SC
National Provider Identifier
1225259039
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X
Legal business name
GREENWOOD GENETICS CENTER, INC.
Practice address
1911 Thurmond Mall
Columbia, SC 29201-2375
Phone
(803) 799-5390
Fax
(803) 799-5391
NPI assigned
May 1, 2007
Organization subpart
Yes
Parent organization
GREENWOOD GENETIC CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Paul Pridmore
Title
Coo
Phone
(864) 941-8100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ph.D. Medical GeneticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 170100000X SC
Clinical Genetics (M.D.) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207SG0201X Primary
Developmental - Behavioral Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0006X

Addresses

Primary practice location

1911 Thurmond Mall
Columbia, SC 29201-2375

Mailing address

101 Gregor Mendel Cir
Greenwood, SC 29646-2316
Phone (864) 388-1072

Other identifiers 1

IdentifierTypeStateIssuer
PA2005MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031226000075 SC Part B Supplier - Clinic/Group Practice 9830097039 Receives reassigned benefits from 12 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, SC; North Charleston, SC; Greenwood, SC; Florence, SC; Columbia, SC

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Greenwood Genetic Cente5 organizations share this tax ID, including this one
Part of
Greenwood Genetic Cente

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1911 Thurmond Mall
Columbia, SC 29201
Phone (803) 356-6854

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1225259039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 GREGOR MENDEL CIR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462316",
            "telephone_number": "864-388-1072",
            "fax_number": "864-388-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 THURMOND MALL",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292012375",
            "telephone_number": "803-799-5390",
            "fax_number": "803-799-5391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWOOD GENETICS CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENWOOD GENETIC CENTER",
        "enumeration_date": "2007-05-01",
        "last_updated": "2022-07-21",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "PRIDMORE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "864-941-8100"
    },
    "taxonomies": [
        {
            "code": "170100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Medical Genetics, Ph.D. Medical Genetics",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "207SG0201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA2005",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.