Individual provider Active NPI

Peter Wrzesinski, MD

  • Psychiatry Physician
  • Spartanburg, SC
National Provider Identifier
1508486507
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
91720 Issued in SC
Practice address
1700 Skylyn Dr
Spartanburg, SC 29307-1041
Phone
(864) 573-3000
NPI assigned
Apr 20, 2020
Last updated
Jul 1, 2024By the provider in NPPES
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 91720 SC Primary
Psychiatry Physician 2084P0800X 340232 LA

Addresses

Primary practice location

1700 Skylyn Dr
Spartanburg, SC 29307-1041

Mailing address

101 E Wood St
Spartanburg, SC 29303-3040
Phone (864) 560-6000

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
I20240903001522 SC Practitioner - Psychiatry 7517406622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Louisiana State University School of Medicine in Shreveport, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, 1,060 clinicians

Practice addresses (Care Compare)

391 Serpentine Dr
Suite 400
Spartanburg, SC 29303-3081
Phone (864) 560-7517

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
340232LAMDPsychiatry Physician
91720SCMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Psychiatry CurrentSince Aug 1, 2024 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center CurrentSince Aug 1, 2024 Accepting new patients
Spartanburg Medical Center Past Accepting new patients

Locations

2755 S Highway 14
Ste 1200D
Greer, SC 29650
Phone (864) 849-9333

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554

1700 Skylyn Dr
Spartanburg, SC 29307
Phone (864) 573-3123

391 Serpentine Dr
Ste 400
Spartanburg, SC 29303
Phone (864) 560-7517

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1508486507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E WOOD ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033040",
            "telephone_number": "864-560-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 SKYLYN DR",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071041",
            "telephone_number": "864-573-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRZESINSKI",
        "first_name": "PETER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "U",
        "enumeration_date": "2020-04-20",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "91720",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "340232",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.