Wayne Chavis

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

364SHO200X Issued in SC

Practice address

7223 Kendallwood CT
Fort Mill, SC 29715-6219

Phone

(803) 357-1105

NPI assigned

Feb 27, 2017

Last updated

Feb 27, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fort Mill Home Care

  • Home Health Agency
  • Fort Mill, SC
  • NPI 1659895183
  NPD (past) Authorized official

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

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488153600000",
    "number": "1417497314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7223 KENDALLWOOD CT",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297156219",
            "telephone_number": "803-357-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7223 KENDALLWOOD CT",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297156219",
            "telephone_number": "803-357-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAVIS",
        "first_name": "WAYNE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "SC",
            "license": "364SHO200X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364SHO200X",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Disabilities Residential Treatment Facility in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Physical Disabilities Residential Treatment Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; 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.