Greenville Age Management Medical Institute, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

14183 Issued in SC

Legal business name

GREENVILLE AGE MANAGEMENT MEDICAL INSTITUTE, LLC

Practice address

540 Old Howell Rd
Greenville, SC 29615-1969

Phone

(864) 365-0100

NPI assigned

Nov 14, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Marcela Young, M.D.NPI 1497880678

Title

Owner

Phone

(864) 365-0100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marcela V Young, M.D.

  • Internal Medicine Physician
  • Greenville, SC
  • NPI 1497880678
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384387200000",
    "number": "1275963175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 OLD HOWELL RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296151969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 OLD HOWELL RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296151969",
            "telephone_number": "864-365-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE AGE MANAGEMENT MEDICAL INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-14",
        "last_updated": "2013-11-14",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "MARCELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-365-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "SC",
            "license": "14183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Schnoor Greene, M.D.
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• Primary Care Clinic/Center in Greenville, SC
• Providers in Greenville, SC by specialty
• Primary Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; 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.