Individual provider Active NPI

Autumn Terry Phillips, APRN

  • Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1417843020
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
29967 Issued in SC
Practice address
8595 Pelham Rd Ste 400
Greenville, SC 29615-5763
Phone
(864) 316-8984
Fax
(877) 337-6283
NPI assigned
Jun 18, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 29967 SC Primary

Addresses

Primary practice location

8595 Pelham Rd Ste 400
Greenville, SC 29615-5763

Mailing address

255 Shadybrook Dr
Summerville, SC 29486-2480
Phone (843) 870-2048

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250814003439 SC Practitioner - Nurse Practitioner 4082113386 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

255 Shadybrook Dr
Summerville, SC 29486-2480

3090 Bristol St
Suite 200
Costa Mesa, CA 92626-3034

350 Bedford St
Suite 406a
Stamford, CT 06901-1738

677 Broadway
Suite 7
Albany, NY 12207-2553

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Services Group, P.C. CurrentSince Jul 7, 2025 Accepting new patients
Careconnectmd South Carolina P.C. CurrentSince Sep 1, 2025 Accepting new patients
Psgsc MSSP, P.C. CurrentSince Sep 28, 2025 Accepting new patients

Locations

3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182

8595 Pelham Rd
Ste 400
Greenville, SC 29615
Phone (864) 316-8984

2 Griffith Rd
Greenville, SC 29607
Phone (864) 276-8583

1240 Winnowing Way
Unit 102
Mt Pleasant, SC 29466
Phone (828) 396-5634

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1750204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1417843020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 SHADYBROOK DR",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294862480",
            "telephone_number": "843-870-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8595 PELHAM RD STE 400",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296155763",
            "telephone_number": "864-316-8984",
            "fax_number": "877-337-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "AUTUMN",
        "middle_name": "TERRY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-18",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "29967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.