Thrive Essential Wellness, Inc.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Legal business name

THRIVE ESSENTIAL WELLNESS, INC.

Practice address

1511 9TH Ave Ste a
Conway, SC 29526-4126

Phone

(843) 488-1894

Fax

(843) 488-2786

NPI assigned

Jul 5, 2018

Last updated

Jul 5, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Greg D Tallent, PA-C

Title

PA-C, Vice President

Phone

(843) 251-6688

Specialties & licenses 1

Addresses

Other identifiers 7

Locations

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.

• Gregory Derrick Tallent, PAC

  • Physician Assistant
  • Raleigh, NC
  • NPI 1982716585

  Medical

  NPD

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530748800000",
    "number": "1407342116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 9TH AVE STE A",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295264126",
            "telephone_number": "843-488-1894",
            "fax_number": "843-488-2786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 9TH AVE STE A",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295264126",
            "telephone_number": "843-488-1894",
            "fax_number": "843-488-2786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVE ESSENTIAL WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-05",
        "last_updated": "2018-07-05",
        "status": "A",
        "authorized_official_last_name": "TALLENT",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PA-C, VICE PRESIDENT",
        "authorized_official_telephone_number": "843-251-6688",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "1245535574",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245535574",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982716585",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "1982716586",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942532023",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "1942532023",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "1982716585",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arthur Tyler Melo Thomas, DO
• William Kody Thomas
• Crystal Thompson
• Gladys A Thompson, MS, M.ED.
• James Dugan Thorderson, DO
• Karen A Tiller
• Kimerly L Tisdale, MA
• Shawnta' Tyrrell Tisdale
• Debra Todd
• Kermit Randy Todd, RPH

• Medical Physician Assistant in Conway, SC
• Providers in Conway, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.

Verify at the official NPI Registry.