NPIMap

Organization Active NPI

Proactive MD,SC,P.a.

  • Family Medicine Physician
  • Mauldin, SC
National Provider Identifier
1235773979
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROACTIVE MD,SC,P.A.
Doing business as
Proactive MD Mauldin Health Center
Practice address
787 E Butler Rd Ste B
Mauldin, SC 29662-3276
Phone
(864) 501-0751
NPI assigned
Nov 6, 2019
Organization subpart
Yes
Parent organization
PROACTIVE MD,SC,P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

Name
Mark Allen Kemble, MD
Title
Cmo
Phone
(864) 501-0751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

787 E Butler Rd Ste B
Mauldin, SC 29662-3276

Mailing address

124 Allawood CT
Simpsonville, SC 29681-6207
Phone (864) 501-0751

Other names 2

  • Proactive MD Mauldin Health Center Doing business as
  • PROACTIVE MD Other name

National Provider Directory

National Provider Directory
Tax ID family
Proactive MD Scpa19 organizations share this tax ID, including this one
Part of
Proactive MD Scpa

Other organizations with this tax ID 18

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

View all 18

Locations

787 E Butler Rd
Ste B
Mauldin, SC 29662

Practitioners & affiliated clinicians

Practitioners 2

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": "1572998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1235773979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ALLAWOOD CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296816207",
            "telephone_number": "864-501-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "787 E BUTLER RD STE B",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296623276",
            "telephone_number": "864-501-0751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MD,SC,P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROACTIVE MD,SC,P.A.",
        "enumeration_date": "2019-11-06",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "KEMBLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "864-501-0751",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive MD Mauldin Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROACTIVE MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mauldin, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.