NPIMap

Individual provider Active NPI

Brent Moister, MD

  • Plastic and Reconstructive Surgery Physician
  • Greenville, SC
National Provider Identifier
1306042254
Registry record updated Jul 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
36140 Issued in SC
Practice address
24 Memorial Medical Dr
Greenville, SC 29605
Phone
(864) 697-2009
Fax
(864) 697-2009
NPI assigned
Jun 26, 2007
Last updated
Jul 18, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 2007018104 MO
Plastic and Reconstructive Surgery Physician 2086S0122X 36140 SC Primary

Addresses

Primary practice location

24 Memorial Medical Dr
Greenville, SC 29605

Mailing address

24 Memorial Medical Dr
Greenville, SC 29605-4452
Phone (864) 697-2009

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
I20131016000233 SC Practitioner - Plastic and Reconstructive Surgery 8820222359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Medical College of Georgia School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

24 Memorial Medical Dr
Greenville, SC 29605-4452
Phone (864) 478-8748

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36140SCMDPharmacist
2007018104MOMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Plastic Surgery LLC Plastic and Reconstructive Surgery CurrentSince Sep 1, 2013 Accepting new patients

Locations

24 Memorial Medical Dr
Greenville, SC 29605
Phone (864) 295-4160

Organizations & group practices 1

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

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531872000000",
    "number": "1306042254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054452",
            "telephone_number": "864-697-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29605",
            "telephone_number": "864-697-2009",
            "fax_number": "864-697-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOISTER",
        "first_name": "BRENT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-26",
        "last_updated": "2018-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MO",
            "license": "2007018104",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "SC",
            "license": "36140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.