NPIMap

Organization Active NPI

Proactive MD FL LLC

  • Primary Care Clinic/Center
  • Simpsonville, SC
National Provider Identifier
1386490126
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PROACTIVE MD FL LLC
Practice address
124 Allawood CT
Simpsonville, SC 29681-6207
Phone
(864) 501-0751
NPI assigned
Apr 24, 2024
Last updated
Apr 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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

Authorized official

Name
Mr. Jason Crumpler, MD
Title
Evp Medical Affairs
Phone
(864) 395-2031

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

124 Allawood CT
Simpsonville, SC 29681-6207

Mailing address

124 Allawood CT
Simpsonville, SC 29681-6207
Phone (864) 501-0751

National Provider Directory

National Provider Directory
Tax ID family
Proactive MD FL LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1386490126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 ALLAWOOD CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296816207",
            "telephone_number": "864-501-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 ALLAWOOD CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296816207",
            "telephone_number": "864-501-0751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE MD FL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "CRUMPLER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "EVP MEDICAL AFFAIRS",
        "authorized_official_telephone_number": "864-395-2031",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simpsonville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.