NPIMap

Organization Active NPI

Carolina Long Term Care Assoicates,PC

  • General Practice Physician
  • Belton, SC
National Provider Identifier
1417989229
Registry record updated Sep 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CAROLINA LONG TERM CARE ASSOICATES,PC
Practice address
113 Wildwood Dr
Belton, SC 29627-9687
Phone
(864) 940-9701
Fax
(864) 338-8760
NPI assigned
Jul 6, 2006
Last updated
Sep 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2010

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

Authorized official

Name
Dr. Kenneth Bryan Heller, MDNPI 1477588655
Title
President
Phone
(864) 940-9701

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU
Family Medicine Physician 207Q00000X NU
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

113 Wildwood Dr
Belton, SC 29627-9687

Mailing address

PO Box 846
Belton, SC 29627-0846
Phone (864) 940-9701

Other identifiers 1

IdentifierTypeStateIssuer
GP3289MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1417989229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846",
            "city": "BELTON",
            "state": "SC",
            "postal_code": "296270846",
            "telephone_number": "864-940-9701",
            "fax_number": "864-338-8760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 WILDWOOD DR",
            "city": "BELTON",
            "state": "SC",
            "postal_code": "296279687",
            "telephone_number": "864-940-9701",
            "fax_number": "864-338-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA LONG TERM CARE ASSOICATES,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "HELLER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-940-9701",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3289",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belton, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.