Individual provider Active NPI

Stephen D. Watson, M.D., PHD.

  • Pain Medicine (Anesthesiology) Physician
  • Easley, SC
National Provider Identifier
1265625321
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
93018 Issued in SC
Practice address
201A Richard St.
Easley, SC 29640
Phone
(864) 343-4190
NPI assigned
Aug 22, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 35-06-3329 OH
Interventional Pain Medicine Physician 208VP0014X ME105674 FL
Pain Medicine (Anesthesiology) Physician 207LP2900X 93018 SC Primary

Addresses

Primary practice location

201A Richard St.
Easley, SC 29640

Mailing address

10903 Sheldon Rd
Tampa, FL 33626-4702
Phone (813) 920-3022

Other practice location 1

10903 Sheldon Rd
Tampa, FL 33626-4702
Phone (813) 920-3022

Other identifiers 1

IdentifierTypeStateIssuer
0884691MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230921000383 FL Practitioner - Pain Management 2365499050 Reassigns benefits to 1 organization
I20240923003643 SC Practitioner - Anesthesiology 2365499050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain Management
Education
Wright State University Boonshoft School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

13055 Summerfield Square Dr
Riverview, FL 33578-7402
Phone (813) 741-2473

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
93018SCMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summerfield Medical Clinic MD PA CurrentSince Jun 1, 2023 Accepting new patients
Premier Pain Solutions PLLC Pain Medicine CurrentSince Sep 9, 2024 Accepting new patients
Premier Pain Solutions PLLC Pain Medicine CurrentSince Sep 9, 2024 Accepting new patients

Locations

13055 Summerfield Square Dr
Riverview, FL 33578
Phone (813) 234-9409

13055 Summerfield Square Dr
#D
Riverview, FL 33578
Phone (813) 741-2473

201 Richard St
#A
Easley, SC 29640
Phone (828) 221-0121

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.

NPI Registry JSON

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1265625321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10903 SHELDON RD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336264702",
            "telephone_number": "813-920-3022",
            "fax_number": "813-920-7666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201A RICHARD ST.",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "29640",
            "telephone_number": "864-343-4190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10903 Sheldon Rd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336264702",
            "country_code": "US",
            "telephone_number": "813-920-3022",
            "fax_number": "813-920-7666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "STEPHEN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D., PHD.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-22",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OH",
            "license": "35-06-3329",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "FL",
            "license": "ME105674",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "SC",
            "license": "93018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0884691",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Easley, SC

Sources for this page

Verify at the official NPI Registry.