NPIMap

Individual provider Active NPI

Daniel David Divilbiss, MD

  • Sports Medicine (Family Medicine) Physician
  • Greenwood, SC
National Provider Identifier
1316979982
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
27947 Issued in SC
Practice address
155 Academy Ave
Greenwood, SC 29646-3869
Phone
(864) 725-4865
Fax
(864) 725-4883
NPI assigned
Jul 6, 2006
Last updated
Dec 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 27947 SC
Sports Medicine (Family Medicine) Physician 207QS0010X 27947 SC Primary

Addresses

Primary practice location

155 Academy Ave
Greenwood, SC 29646-3869

Mailing address

155 Academy Ave
Greenwood, SC 29646-3869
Phone (864) 725-4865

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ddivilbiss127898@selfregional.direct-ci.net

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
I20080520000651 SC Practitioner - Family PracticePractitioner - Emergency Medicine 9436228251 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Regional HealthcareGroup PAC ID 4082527742, 159 clinicians

Practice addresses (Care Compare)

155 Academy Ave
Greenwood, SC 29646-3869
Phone (864) 725-4865

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Self Regional Healthcare Partners CurrentSince Jan 1, 2019 Accepting new patients
Self Regional Healthcare Family Medicine CurrentSince Aug 26, 2013 Accepting new patients
Self Regional Healthcare Partners Family Medicine CurrentSince Jan 1, 2019 Accepting new patients
Self Regional Healthcare Past Accepting new patients
Self Regional Healthcare Family Medicine Past Accepting new patients

Locations

300 Ridge Medical Plaza Rd
Edgefield, SC 29824
Phone (803) 637-3174

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

155 Academy Ave
Greenwood, SC 29646
Phone (864) 725-4865

Interoperability endpoints

  • Direct secure messaging: ddivilbiss127898@selfregional.direct-ci.net

Organizations & group practices 5

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 6

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1316979982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 ACADEMY AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463869",
            "telephone_number": "864-725-4865",
            "fax_number": "864-725-4883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 ACADEMY AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463869",
            "telephone_number": "864-725-4865",
            "fax_number": "864-725-4883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVILBISS",
        "first_name": "DANIEL",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "27947",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "SC",
            "license": "27947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ddivilbiss127898@selfregional.direct-ci.net",
            "affiliation": "N",
            "address_1": "155 Academy Ave",
            "city": "Greenwood",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296463869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.