NPIMap

Individual provider Active NPI

Gwendolyn Rose Smith, DO

  • Family Medicine Physician
  • Travelers Rest, SC
National Provider Identifier
1225488620
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
91090 Issued in SC
Practice address
807 N Main St
Travelers Rest, SC 29690-1551
Phone
(864) 455-9790
Fax
(864) 455-9795
NPI assigned
Jun 16, 2016
Last updated
Apr 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS018950 PA
Family Medicine Physician 207Q00000X 2021-02165 NC
Family Medicine Physician 207Q00000X 91090 SC Primary

Addresses

Primary practice location

807 N Main St
Travelers Rest, SC 29690-1551

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 695-6697

Other practice location 1

15 Skyland Inn Dr
Arden, NC 28704-7714
Phone (828) 681-5327

Other practice location 2

740 High St
Williamsport, PA 17701-3102
Phone (570) 321-2345

Other practice location 3

471 Hepburn St
Williamsport, PA 17701-6122
Phone (267) 567-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211021003219 NC Practitioner - Family Practice 3870886401
I20240410003571 SC Practitioner - Family Practice 3870886401 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health-UpstateGroup PAC ID 5698063162, shared by 28 NPIs, 8 clinicians

Practice addresses (Care Compare)

807 N Main St
Travelers Rest, SC 29690-1551
Phone (864) 834-5132

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
91090SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Apr 29, 2024 Accepting new patients
Prisma Health University Medical Group Family Medicine CurrentSince Apr 29, 2024 Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

807 N Main St
Travelers Rst, SC 29690
Phone (864) 834-5132

Interoperability endpoints

  • Direct secure messaging: gsmith761164@direct.ghs.myhfn.org

Organizations & group practices 2

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 55

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

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1225488620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-695-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 N MAIN ST",
            "city": "TRAVELERS REST",
            "state": "SC",
            "postal_code": "296901551",
            "telephone_number": "864-455-9790",
            "fax_number": "864-455-9795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Skyland Inn Dr",
            "address_purpose": "LOCATION",
            "city": "Arden",
            "state": "NC",
            "postal_code": "287047714",
            "country_code": "US",
            "telephone_number": "828-681-5327",
            "fax_number": "828-681-9846",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "740 High St",
            "address_purpose": "LOCATION",
            "city": "Williamsport",
            "state": "PA",
            "postal_code": "177013102",
            "country_code": "US",
            "telephone_number": "570-321-2345",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "471 Hepburn St",
            "address_purpose": "LOCATION",
            "city": "Williamsport",
            "state": "PA",
            "postal_code": "177016122",
            "country_code": "US",
            "telephone_number": "267-567-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GWENDOLYN",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-16",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS018950",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2021-02165",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "91090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Travelers Rest, SC

Sources for this page

Verify at the official NPI Registry.