NPIMap

Individual provider Active NPI

Linda L Redderson, MD

  • Family Medicine Physician
  • Simpsonville, SC
National Provider Identifier
1265402192
Registry record updated Nov 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16718 Issued in SC
Practice address
Holly Tree Family Practice
11338 Highway 14
Simpsonville, SC 29681-5637
Phone
(864) 297-7091
Fax
(864) 297-6335
NPI assigned
Jan 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16718 SC Primary

Addresses

Primary practice location

Holly Tree Family Practice
11338 Highway 14
Simpsonville, SC 29681-5637

Mailing address

PO Box 743294
Atlanta, GA 30374-3294
Phone (864) 855-2873

Other identifiers 2

IdentifierTypeStateIssuer
167189MedicaidSC
GP2352MedicaidSC

Other names 1

  • Linda L Giambalvo Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080124000041 SC Practitioner - Family Practice 0840372231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Carolina School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Francis Physician Services IncGroup PAC ID 6608826821, 106 clinicians

Practice addresses (Care Compare)

1200 Brookfield Blvd
Suite 400B
Greenville, SC 29607-6583
Phone (864) 605-3721

1338 Hwy 14
Simpsonville, SC 29681-5637
Phone (864) 297-7091

1340 Hwy 14
Simpsonville, SC 29681-5637
Phone (864) 295-2131

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16718SCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
St Francis Physician Services Inc Family Medicine CurrentSince Jan 2, 2008 Accepting new patients
St Francis Physician Services Inc Family Medicine CurrentSince Jan 2, 2008 Accepting new patients
St Francis Physician Services Inc Family Medicine Past Accepting new patients

Locations

1200 Brookfield Blvd
Ste 400B
Greenville, SC 29607
Phone (864) 605-3721

1338 Highway 14
Simpsonville, SC 29681
Phone (864) 297-7091

Interoperability endpoints

  • Direct secure messaging: lredderson1154975@direct.bsmhealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 54

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

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542758400000",
    "number": "1265402192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743294",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743294",
            "telephone_number": "864-855-2873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HOLLY TREE FAMILY PRACTICE",
            "address_2": "11338 HIGHWAY 14",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296815637",
            "telephone_number": "864-297-7091",
            "fax_number": "864-297-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDERSON",
        "first_name": "LINDA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-24",
        "last_updated": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "16718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167189",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2352",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LINDA",
            "last_name": "GIAMBALVO",
            "middle_name": "L",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Simpsonville, SC

Sources for this page

Verify at the official NPI Registry.