NPIMap

Organization Active NPI

Magnolia Medical Group Inc

  • Physical Therapist
  • Greenville, SC
National Provider Identifier
1386629558
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MAGNOLIA MEDICAL GROUP INC
Practice address
800 Pelham Rd
Third Floor - Physical Therapy Department
Greenville, SC 29615-3300
Phone
(864) 752-3357
Fax
(678) 840-2112
NPI assigned
Dec 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Authorized official

Name
Victor M Cortina, PTNPI 1578596037
Title
Cfo
Phone
(864) 621-5646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X SC Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X SC
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X SC

Addresses

Primary practice location

800 Pelham Rd
Third Floor - Physical Therapy Department
Greenville, SC 29615-3300

Mailing address

PO Box 25306
Greenville, SC 29616-0306
Phone (864) 752-3357

Other identifiers 1

IdentifierTypeStateIssuer
GP3940MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051214000026 SC Part B Supplier - Clinic/Group Practice 3779504105 Receives reassigned benefits from 6 practitioners
Practice locations: Greenville, SC; Greer, SC; Laurens, SC

National Provider Directory

National Provider Directory

Locations

2078 Woodruff Rd
#C
Greenville, SC 29607
Phone (864) 752-3357

401 Guess St
Ste 200
Greenville, SC 29605
Phone (864) 346-0391

50 Directors Dr
Greenville, SC 29615
Phone (864) 655-7757

800 Pelham Rd
Fl Third
Greenville, SC 29615
Phone (864) 346-0391

320 Tandem Dr
Greer, SC 29650
Phone (864) 655-7757

509 W Poinsett St
Greer, SC 29650
Phone (864) 655-7757

221 Hillcrest Dr
Laurens, SC 29360

211 Hillcrest Dr
Laurens, SC 29360
Phone (864) 346-0391

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1134259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1386629558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25306",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296160306",
            "telephone_number": "864-752-3357",
            "fax_number": "678-840-2112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PELHAM RD",
            "address_2": "THIRD FLOOR - PHYSICAL THERAPY DEPARTMENT",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153300",
            "telephone_number": "864-752-3357",
            "fax_number": "678-840-2112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-11",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "CORTINA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "864-621-5646",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3940",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.