Individual provider Active NPI

Laure A.N. Utecht, M.D.

  • Pediatric Infectious Diseases Physician
  • Greenville, SC
National Provider Identifier
1457396053
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X
License
20991 Issued in SC
Practice address
200 Patewood Dr
Suite A200
Greenville, SC 29615-3593
Phone
(864) 454-5130
Fax
(864) 454-5126
NPI assigned
Jun 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Infectious Diseases Physician 2080P0208X 20991 SC Primary

Addresses

Primary practice location

200 Patewood Dr
Suite A200
Greenville, SC 29615-3593

Mailing address

1 Independence PT
Suite 212
Greenville, SC 29615-4545
Phone (864) 797-6044

Other identifiers 5

IdentifierTypeStateIssuer
209919MedicaidSC
7928169OtherSCAETNA ID
576007863095OtherSCBCBS OF SC ID
576007863096OtherSCBLUE CHOICE OF SC
370017228OtherSCRR MEDICARE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040225000904 SC Practitioner - Pediatric Medicine 0345136453 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20991SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Jan 1, 2010 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Greenville Health System Past Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

100 Augusta St
Greenville, SC 29601
Phone (864) 455-2600

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

877 W Faris Rd
Ste C
Greenville, SC 29605
Phone (864) 455-8147

1210 W Faris Rd
Greenville, SC 29605
Phone (864) 295-4410

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

2104 Woodruff Rd
Greenville, SC 29607
Phone (864) 676-1072

200 Patewood Dr
Ste A200
Greenville, SC 29615
Phone (864) 454-5115

Interoperability endpoints

  • Direct secure messaging: lutecht7099@direct.ghs.myhfn.org

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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1457396053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT",
            "address_2": "SUITE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154545",
            "telephone_number": "864-797-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "SUITE A200",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-5130",
            "fax_number": "864-454-5126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UTECHT",
        "first_name": "LAURE",
        "middle_name": "A.N.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-18",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "SC",
            "license": "20991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209919",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID",
            "identifier": "7928169",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF SC ID",
            "identifier": "576007863095",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE OF SC",
            "identifier": "576007863096",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "370017228",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.