NPIMap

Organization Active NPI

Upstate Podiatry Group, PA

  • Foot & Ankle Surgery Podiatrist
  • Spartanburg, SC
National Provider Identifier
1396487336
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
UPSTATE PODIATRY GROUP, PA
Practice address
1420 John B White Sr Blvd
Spartanburg, SC 29306-3927
Phone
(864) 399-9070
NPI assigned
Apr 11, 2022
Organization subpart
Yes
Parent organization
UPSTATE PODIATRY GROUP, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Authorized official

Name
Stephanie Riddle
Title
Cfo
Phone
(864) 979-3635

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

1420 John B White Sr Blvd
Spartanburg, SC 29306-3927

Mailing address

801 SE Main St
Simpsonville, SC 29681-7150
Phone (864) 399-9070

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://pwx.cernerworks.com/Citrix/ProdWeb/ Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130912000619 SC Part B Supplier - Clinic/Group Practice 5698919694 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greer, SC; Laurens, SC; Simpsonville, SC; Spartanburg, SC

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Upstate Podiatry Group PA3 organizations share this tax ID, including this one
Part of
Upstate Podiatry Group PA

Other organizations with this tax ID 2

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

Locations

1420 John B White SR Blvd
Spartanburg, SC 29306
Phone (864) 399-9070

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1396487336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SE MAIN ST",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296817150",
            "telephone_number": "864-399-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 JOHN B WHITE SR BLVD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293063927",
            "telephone_number": "864-399-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE PODIATRY GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UPSTATE PODIATRY GROUP, PA",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "RIDDLE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "864-979-3635"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://pwx.cernerworks.com/Citrix/ProdWeb/",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1420 John B White SR Blvd",
            "city": "Spartanburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293063927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; 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.