NPIMap

Individual provider Active NPI

Vicky Gutierrez, PA-C

  • Physician Assistant
  • Greenville, SC
National Provider Identifier
1346614732
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2483 Issued in SC
Practice address
890 W Faris Rd Ste 310
Greenville, SC 29605-4281
Phone
(864) 455-8300
Fax
(864) 455-8310
NPI assigned
Nov 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 2483 SC
Physician Assistant 363A00000X 2483 SC Primary

Addresses

Primary practice location

890 W Faris Rd Ste 310
Greenville, SC 29605-4281

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

10630 Clemson Blvd Ste 100
Seneca, SC 29678-4545
Phone (864) 482-6000

Other identifiers 2

IdentifierTypeStateIssuer
SC7826OtherSCMEDICARE
2542PAMedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vgutierrez163244@direct.ghs.myhfn.org Direct

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
I20160407001359 SC Practitioner - Physician Assistant 4981902913 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health University Medical GroupGroup PAC ID 8325950983, 2,467 clinicians

Practice addresses (Care Compare)

210 Freeman Farm Rd
Duncan, SC 29334-9398
Phone (864) 968-5123

701 Grove Rd
Greenville, SC 29605-4210

890 W Faris Rd
Greenville, SC 29605-4281

Hospital & facility affiliations

  • Prisma Health Greenville Memorial Hospital Hospital, Greenville, SC, CCN 420078

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2483SCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Feb 6, 2017 Accepting new patients
Prisma Health-Upstate CurrentSince Feb 6, 2017 Accepting new patients
Prisma Health University Medical Group CurrentSince Feb 6, 2017 Accepting new patients
Prisma Health-Upstate CurrentSince Feb 6, 2017 Accepting new patients
Prisma Health University Medical Group Past Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

200 Patewood Dr
Ste B180
Greenville, SC 29615
Phone (864) 286-3700

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

890 W Faris Rd
Ste 310
Greenville, SC 29605
Phone (864) 455-8300

701 Grove Rd
Fl 5
Greenville, SC 29605
Phone (864) 455-4411

13 Edgewood Dr
Greenville, SC 29605
Phone (864) 271-6060

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

298 Memorial Dr
Seneca, SC 29672
Phone (864) 482-3100

10630 Clemson Blvd
Ste 100
Seneca, SC 29678
Phone (864) 260-9910

103 Omni Dr
#B
Seneca, SC 29672
Phone (864) 482-3285

Organizations & group practices 6

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.

Hospital & facility affiliations 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1346614732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 W FARIS RD STE 310",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054281",
            "telephone_number": "864-455-8300",
            "fax_number": "864-455-8310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10630 Clemson Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Seneca",
            "state": "SC",
            "postal_code": "296784545",
            "country_code": "US",
            "telephone_number": "864-482-6000",
            "fax_number": "864-482-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "VICKY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-23",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "2483",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "2483",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "SC7826",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2542PA",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vgutierrez163244@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "vgutierrez163244@direct.ghs.myhfn.org",
            "address_1": "10630 Clemson Blvd Ste 100",
            "city": "Seneca",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296784545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.