NPIMap

Organization Active NPI

Anderson District 4

  • School Psychologist
  • Pendleton, SC
National Provider Identifier
1508102328
Registry record updated Dec 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
3046 Issued in SC
Legal business name
ANDERSON DISTRICT 4
Practice address
315 E Queen St
Pendleton, SC 29670-1721
Phone
(864) 403-2000
Fax
(864) 403-2099
NPI assigned
Dec 26, 2012
Last updated
Dec 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2012

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

Authorized official

Name
Mr. Thomas Wayne Goodwin, LPESNPI 1750628939
Title
Director of Special Education
Phone
(864) 403-2000

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 3046 SC Primary

Addresses

Primary practice location

315 E Queen St
Pendleton, SC 29670-1721

Mailing address

315 E Queen St
Pendleton, SC 29670-1721
Phone (864) 403-2000

Other identifiers 1

IdentifierTypeStateIssuer
SD0404MedicaidSC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2206111Anderson School District 4315 E Queen Street, Pendleton, SC 29670Certificate of waiverDec 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Anderson District 46 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356480000000",
    "number": "1508102328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E QUEEN ST",
            "city": "PENDLETON",
            "state": "SC",
            "postal_code": "296701721",
            "telephone_number": "864-403-2000",
            "fax_number": "864-403-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E QUEEN ST",
            "city": "PENDLETON",
            "state": "SC",
            "postal_code": "296701721",
            "telephone_number": "864-403-2000",
            "fax_number": "864-403-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON DISTRICT 4",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-26",
        "last_updated": "2012-12-26",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DIRECTOR OF SPECIAL EDUCATION",
        "authorized_official_telephone_number": "864-403-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPES"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "SC",
            "license": "3046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0404",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pendleton, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.