Organization Active NPI

Pecora Medical, PC

  • Internal Medicine Physician
  • Anderson, SC
National Provider Identifier
1275825994
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PECORA MEDICAL, PC
Practice address
803 N Fant St Ste 3a
Anderson, SC 29621-5718
Phone
(864) 225-7401
Fax
(864) 225-7201
NPI assigned
May 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Authorized official

Name
Claudia Panameno, MBA
Title
Practice Manager
Phone
(864) 225-7401

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X
Hospice and Palliative Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0002X

Addresses

Primary practice location

803 N Fant St Ste 3a
Anderson, SC 29621-5718

Mailing address

PO Box 357
Anderson, SC 29622-0357
Phone (864) 225-7401

Other identifiers 1

IdentifierTypeStateIssuer
GP8549MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140916002278 SC Part B Supplier - Clinic/Group Practice 2769660695 Receives reassigned benefits from 2 practitioners
Practice locations: Anderson, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0929061Pecora Medical & Pain PC803 North Fant St, Ste 3a, Anderson, SC 29621Certificate of waiverJun 2, 2027

National Provider Directory

National Provider Directory

Locations

123 Whitehall Rd
Anderson, SC 29625
Phone (864) 225-7401

Practitioners & affiliated clinicians

Practitioners 4

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": "1305158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1275825994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 357",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296220357",
            "telephone_number": "864-225-7401",
            "fax_number": "864-225-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 N FANT ST STE 3A",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296215718",
            "telephone_number": "864-225-7401",
            "fax_number": "864-225-7201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECORA MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-12",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "PANAMENO",
        "authorized_official_first_name": "CLAUDIA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "864-225-7401",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP8549",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.