Active NPI
Tod Martin Hanover, MD
- Vascular Surgery Physician
- Greenville, SC
National Provider Identifier
1386757128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 14730
- Practice address
- 200 Patewood Dr
Suite C300
Greenville, SC 29615-3593 - Phone
- (864) 454-8272
- Fax
- (864) 454-2875
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 14730 | SC | Primary |
Addresses
Primary practice location
200 Patewood Dr
Suite C300
Greenville, SC 29615-3593
Mailing address
1 Independence PT Ste 212
Greenville, SC 29615-4536
Phone (864) 797-6303
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| N00826 | Medicaid | SC | |
| P00441281 | Other | SC | RR MEDICARE |
| 576007863200 | Other | SC | BCBS |
| P00817221 | Other | SC | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Self Regional Healthcare | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517443200000",
"number": "1386757128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 INDEPENDENCE PT STE 212",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296154536",
"telephone_number": "864-797-6303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 PATEWOOD DR",
"address_2": "SUITE C300",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296153593",
"telephone_number": "864-454-8272",
"fax_number": "864-454-2875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANOVER",
"first_name": "TOD",
"middle_name": "MARTIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2018-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "SC",
"license": "14730",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N00826",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00441281",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "576007863200",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00817221",
"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 Feb 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.