NPIMap

Individual provider Active NPI

Kelly Hooton Miller, PA-C

  • Medical Physician Assistant
  • Greenville, SC
National Provider Identifier
1487095956
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
TL3246 Issued in SC
Practice address
1025 Verdae Blvd Ste D
Greenville, SC 29607-4032
Phone
(404) 321-1950
NPI assigned
Jul 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 6862 GA
Medical Physician Assistant 363AM0700X TL3246 SC Primary

Addresses

Primary practice location

1025 Verdae Blvd Ste D
Greenville, SC 29607-4032

Mailing address

1 Independence PT Ste 212
Greenville, SC 29615-4536
Phone (864) 797-6308

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190724001721 SC Practitioner - Physician Assistant 1355568239 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prisma Health University Medical GroupGroup PAC ID 8325950983, 2,467 clinicians

Practice addresses (Care Compare)

1025 Verdae Blvd
Greenville, SC 29607-4032

300 E McBee Ave
Greenville, SC 29601-2842
Phone (864) 797-6220

300 E McBee Ave FL
Suite 4
Greenville, SC 29601-2842

Hospital & facility affiliations

  • Prisma Health Greenville Memorial Hospital Hospital, Greenville, SC, CCN 420078
  • Prisma Health Patewood Hospital Hospital, Greenville, SC, CCN 420102
  • Prisma Health Hillcrest Hospital Hospital, Simpsonville, SC, CCN 420037

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6862GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Jun 10, 2019 Accepting new patients
NSH Cancer Institute Professional Services a LLC CurrentSince Feb 1, 2016 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jun 30, 2014 Accepting new patients
Prisma Health University Medical Group CurrentSince Jun 10, 2019 Accepting new patients
NSH Cancer Institute Professional Services a LLC CurrentSince Feb 1, 2016 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Jun 30, 2014 Accepting new patients

Locations

1498 Klondike Rd SW
Ste 106
Conyers, GA 30094
Phone (770) 761-7260

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

1100 Johnson Fy Rd NE
Ste 510
Sandy Springs, GA 30342
Phone (404) 419-1165

1025 Verdae Blvd
Ste D
Greenville, SC 29607
Phone (864) 242-4683

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

1025 Verdae Blvd
Ste A
Greenville, SC 29607
Phone (864) 242-4683

Organizations & group practices 6

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.

Hospital & facility affiliations 48

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1487095956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT STE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154536",
            "telephone_number": "864-797-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 VERDAE BLVD STE D",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296074032",
            "telephone_number": "404-321-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KELLY",
        "middle_name": "HOOTON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-12",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "6862",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "TL3246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.