NPIMap

Organization Active NPI

Prisma Health University Medical Group

  • Pediatrics Physician
  • Clemson, SC
National Provider Identifier
1225480486
Registry record updated May 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Practice address
208 Frontage Rd
Suite 1
Clemson, SC 29631-1691
Phone
(864) 654-6034
NPI assigned
Jul 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2020

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

Authorized official

Name
Kristi Ann Lawrence
Title
Director Provider Enrollment
Phone
(864) 797-6118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

208 Frontage Rd
Suite 1
Clemson, SC 29631-1691

Mailing address

1 Independence PT Ste 212
Greenville, SC 29615-4536
Phone (864) 385-4790

Other identifiers 1

IdentifierTypeStateIssuer
GP7326MedicaidSC

Other names 1

  • Clemson-Seneca Pediatrics-Clemson Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040108000041 SC Part B Supplier - Clinic/Group Practice 8325950983 Receives reassigned benefits from 236 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clemson, SC; Simpsonville, SC; Seneca, SC; Greenville, SC

National Provider Directory

National Provider Directory
Tax ID family
GHS Partners in Health34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Locations

208 Frontage Rd
Ste 1
Clemson, SC 29631
Phone (864) 654-6034

Other NPIs on the same Medicare enrollment 4

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

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": "1468281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589500800000",
    "number": "1225480486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT STE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154536",
            "telephone_number": "864-385-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 FRONTAGE RD",
            "address_2": "SUITE 1",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296311691",
            "telephone_number": "864-654-6034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH UNIVERSITY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-12",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "864-797-6118"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP7326",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clemson-Seneca Pediatrics-Clemson",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clemson-Seneca Pediatrics-Clemson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clemson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; 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.