Individual provider Active NPI

Amanda Twila Small, M.D.

  • Child Abuse Pediatrics Physician
  • Greenville, SC
National Provider Identifier
1235661273
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Abuse Pediatrics PhysicianTaxonomy code 2080C0008X
License
92386 Issued in SC
Practice address
2905 White Horse Rd
Greenville, SC 29611-6120
Phone
(864) 331-0560
Fax
(864) 241-9277
NPI assigned
Mar 29, 2017
Last updated
Aug 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child Abuse Pediatrics Physician 2080C0008X 92386 SC Primary

Addresses

Primary practice location

2905 White Horse Rd
Greenville, SC 29611-6120

Mailing address

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

Other practice location 1

1 Baylor Plz # Bcm320
Houston, TX 77030-3411
Phone (832) 824-1173

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240729004559 SC Practitioner - Pediatric Medicine 2567909369 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Aug 5, 2024 Accepting new patients
Prisma Health University Medical Group CurrentSince Aug 5, 2024 Accepting new patients

Locations

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

2905 White Horse Rd
Greenville, SC 29611
Phone (864) 331-0560

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

Interoperability endpoints

  • Direct secure messaging: asmall795593@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.

NPI Registry JSON

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1235661273",
    "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": "2905 WHITE HORSE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296116120",
            "telephone_number": "864-331-0560",
            "fax_number": "864-241-9277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Baylor Plz # Bcm320",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303411",
            "country_code": "US",
            "telephone_number": "832-824-1173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMALL",
        "first_name": "AMANDA",
        "middle_name": "TWILA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-29",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080C0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Child Abuse Pediatrics",
            "state": "SC",
            "license": "92386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.