NPIMap

Individual provider Active NPI

Andrew Roudebush, D.O.

  • Family Medicine Physician
  • Greenville, SC
National Provider Identifier
1376540559
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036135207 Issued in IL
Practice address
131 Commonwealth Dr Ste 100
Greenville, SC 29615-4838
Phone
(864) 675-4820
NPI assigned
Jul 4, 2005
Last updated
Sep 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 110832 MO
Family Medicine Physician 207Q00000X 87780 SC
Family Medicine Physician 207Q00000X 036135207 IL Primary

Addresses

Primary practice location

131 Commonwealth Dr Ste 100
Greenville, SC 29615-4838

Mailing address

PO Box 631341
Cincinnati, OH 45263-1341

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
I20220921003795 SC Practitioner - Family Practice 7517967847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

125 Commonwealth Dr
Greenville, SC 29615-4812
Phone (864) 675-4000

317 Saint Francis Dr
Suite 220
Greenville, SC 29601-3976
Phone (864) 255-1901

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue688
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
110832MOMDFamily Medicine Physician
87780SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince Aug 14, 2022 Accepting new patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince Aug 14, 2022 Accepting new patients
Capital Family Care Family Medicine PastSince Oct 16, 2002 Accepting new patients

Locations

131 Commonwealth Dr
Ste 100
Greenville, SC 29615
Phone (864) 675-4820

317 Saint Francis Dr
Ste 220
Greenville, SC 29601
Phone (864) 255-1901

Interoperability endpoints

  • Direct secure messaging: aroudebush1344778@direct.bsmhealth.org

Organizations & group practices 3

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 51

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

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1120435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1376540559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631341",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452631341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 COMMONWEALTH DR STE 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154838",
            "telephone_number": "864-675-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUDEBUSH",
        "first_name": "ANDREW",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-04",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "110832",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "87780",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036135207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.