NPIMap

Centerwell Senior Primary Care (SC) PC

Organization Active NPI Internal Medicine Physician · Greenville, SC

NPI 1376907790 · NPPES record last updated Aug 19, 2024

Key facts

NPI
1376907790
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE (SC) PC
Practice address
101 Orchard Park Dr
Greenville, SC 29615-3531
Phone
(864) 729-6606
Fax
(855) 617-4426
NPI assigned
Apr 12, 2016
Organization subpart
Yes
Parent organization (as reported)
CENTERWELL SENIOR PRIMARY CARE (SC) PC

Authorized official

Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 257

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 257

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2114511Centerwell Senior Primary Care - Orchard Park
101 Orchard Park Drive, Greenville, SC 29615		Certificate of waiverJun 14, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in SC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20160808001129 SC Part B Supplier - Clinic/Group Practice 8729302278 Receives reassigned benefits from 7 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anderson, SC; Greenville, SC; Greer, SC
O20201216002926 SC Part B Supplier - Clinic/Group Practice 2860804796 Receives reassigned benefits from 85 practitioners
8 other NPIs on this enrollment
Practice locations: Greenville, SC; Spartanburg, SC; Seneca, SC; North Charleston, SC; Greer, SC; Charleston, SC; Anderson, SC

National Provider Directory

Tax ID family
Centerwell Senior Primary Care NC PC (4 organizations share this tax ID)
Part of
Centerwell Senior Primary Care NC PC

Locations

6101 Blue Lagoon Dr
Fl 4
Miami, FL 33126

3516 Highway 153
Greenville, SC 29611
Phone (864) 729-6626

1213 Remount Rd
Ste E
North Charleston, SC 29406
Phone (843) 973-5415

4918 Ayers St
Ste 130
Corpus Christi, TX 78415
Phone (361) 400-4355

227 W Kleberg Ave
Kingsville, TX 78363
Phone (361) 592-6451

1911 Rogers Rd
San Antonio, TX 78251
Phone (210) 523-9933

4359 Greco Dr
San Antonio, TX 78222
Phone (210) 648-8200

2211 NW Military Hwy
San Antonio, TX 78213
Phone (210) 696-2264

6801 San Pedro Ave
San Antonio, TX 78216
Phone (726) 224-2300

7031 Marbach Rd
San Antonio, TX 78227
Phone (210) 761-3363

2925 West Ave
San Antonio, TX 78201
Phone (210) 318-4491

4455 Thousand Oaks Dr
San Antonio, TX 78233
Phone (726) 268-7360

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
General Practice Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208D00000X

Addresses

Primary practice location

101 Orchard Park Dr
Greenville, SC 29615-3531

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (305) 500-2000

Other names

  • CenterWell Senior Primary Care-Orchard Park Doing business as
  • Partners in Primary Care-Orchard Park Doing business as
  • Partners in Primary Care NC PC Former legal business name
  • Partners in Primary Care SC PC Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 19, 2024.

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1376907790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 ORCHARD PARK DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153531",
            "telephone_number": "864-729-6606",
            "fax_number": "855-617-4426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE (SC) PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE (SC) PC",
        "enumeration_date": "2016-04-12",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care-Orchard Park",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care-Orchard Park",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care NC PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Partners in Primary Care NC PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Partners in Primary Care SC PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Greenville, SC

All providers in Greenville, SC · Internal Medicine Physician in South Carolina

Sources for this page

Verify at the official NPI Registry.