Individual provider Active NPI

Dane Wilson, DPT

  • Physical Therapist
  • Greenville, SC
National Provider Identifier
1295080356
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6764 Issued in SC
Practice address
1025 Verdae Blvd Ste E
Greenville, SC 29607-4032
Phone
(843) 972-0940
Fax
(843) 881-8452
NPI assigned
Jul 16, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6764 SC Primary

Addresses

Primary practice location

1025 Verdae Blvd Ste E
Greenville, SC 29607-4032

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120809000561 SC Practitioner - Physical Therapist in Private Practice 1557517315 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Medical University of South Carolina College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greenville Proaxis Therapy LLCGroup PAC ID 0244267771, 221 clinicians

Practice addresses (Care Compare)

905 Verdae Blvd
Suite 104
Greenville, SC 29607-4029
Phone (864) 522-6100

Merit-based Incentive Payment System (MIPS)

Final score
87.01 of 100Reported as group
Quality
90
Improvement activities
40
Cost
75.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6764SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
RSFH - Ati Physical Therapy, LLC Physical Therapist CurrentSince Sep 1, 2017 Accepting new patients
Greenville Proaxis Therapy, LLC Physical Therapist CurrentSince Jul 1, 2017 Accepting new patients
RSFH - Ati Physical Therapy, LLC Physical Therapist CurrentSince Sep 1, 2017 Accepting new patients
Greenville Proaxis Therapy LLC CurrentSince Jul 1, 2017 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33299 Collection Ctr Dr
Chicago, IL 60693

33205 Collection Ctr Dr
Chicago, IL 60693

325 Folly Rd
Ste 107
Charleston, SC 29412
Phone (843) 762-0147

5400 International Blvd
Bldg 8821
Charleston, SC 29418
Phone (843) 763-4115

1730 Savannah Hwy
Charleston, SC 29407
Phone (843) 763-4115

1941 Savage Rd
Ste 300A
Charleston, SC 29407
Phone (843) 402-1495

838 Powdersville Rd
Ste T
Easley, SC 29642
Phone (864) 671-1650

905 Verdae Blvd
Ste 104
Greenville, SC 29607
Phone (864) 522-6100

103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753

1025 Verdae Blvd
Ste E
Greenville, SC 29607
Phone (843) 972-0940

200 Patewood Dr
Ste C150
Greenville, SC 29615
Phone (864) 454-0904

203 E Butler Rd
#C
Mauldin, SC 29662
Phone (864) 268-6686

586 Lone Tree Dr
Mt Pleasant, SC 29464
Phone (843) 884-7880

9241 University Blvd
Ste B1
North Charleston, SC 29406
Phone (843) 414-1140

Organizations & group practices 4

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": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1295080356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 VERDAE BLVD STE E",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296074032",
            "telephone_number": "843-972-0940",
            "fax_number": "843-881-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DANE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "6764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.