NPIMap

Individual provider Active NPI

Kendell Cantrell Mature, PA-C

  • Physician Assistant
  • Laurens, SC
National Provider Identifier
1508676099
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MPA.5463 Issued in SC
Practice address
22580 Highway 76 E Ste 300
Laurens, SC 29360-8460
Phone
(864) 725-4673
NPI assigned
Jan 8, 2025
Last updated
Aug 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MPA.5463 SC Primary

Addresses

Primary practice location

22580 Highway 76 E Ste 300
Laurens, SC 29360-8460

Mailing address

7310 Saint Lukes Church Rd
Prosperity, SC 29127-7125

Other practice location 1

2669 Kinard St
Newberry, SC 29108-2911
Phone (803) 276-7570

Other identifiers 1

IdentifierTypeStateIssuer
7977PAMedicaidSC

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
I20250325003122 SC Practitioner - Physician Assistant 1355864851 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Regional HealthcareGroup PAC ID 4082527742, 159 clinicians
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Practice addresses (Care Compare)

115 Academy Ave
Greenwood, SC 29646-3869
Phone (864) 725-7272

155 Academy Ave
Greenwood, SC 29646-3869
Phone (864) 725-4865

1910 A College St
Newberry, SC 29108-2644
Phone (803) 945-4050

22580 Hwy 76 E
Suite 100
Laurens, SC 29360-8460
Phone (864) 833-5986

298 Commerce Dr
Newberry, SC 29108-2953
Phone (803) 321-3232

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5463SCMDPhysical Therapist
MPA.5463SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Self Regional Healthcare CurrentSince Sep 24, 2025 Accepting new patients
Self Regional Healthcare CurrentSince Sep 24, 2025 Accepting new patients
Self Regional Healthcare Current Accepting new patients
Self Medical Group CurrentSince Apr 1, 2025 Accepting new patients
Self Regional Healthcare Past Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

75 Remittance Dr
Dept 6793
Chicago, IL 60675

104 Wells Ave
Greenwood, SC 29646

155 Academy Ave
Greenwood, SC 29646
Phone (864) 725-4865

22580 Highway 76 E
Ste 300
Laurens, SC 29360
Phone (864) 725-4183

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: kcantrell543865@selfregional.direct-ci.net

Organizations & group practices 7

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 5

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": "1736294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1508676099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7310 SAINT LUKES CHURCH RD",
            "city": "PROSPERITY",
            "state": "SC",
            "postal_code": "291277125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22580 HIGHWAY 76 E STE 300",
            "city": "LAURENS",
            "state": "SC",
            "postal_code": "293608460",
            "telephone_number": "864-725-4673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2669 Kinard St",
            "address_purpose": "LOCATION",
            "city": "Newberry",
            "state": "SC",
            "postal_code": "291082911",
            "country_code": "US",
            "telephone_number": "803-276-7570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATURE",
        "first_name": "KENDELL",
        "middle_name": "CANTRELL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-08",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "MPA.5463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7977PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurens, SC

Sources for this page

Verify at the official NPI Registry.