NPIMap

Organization Active NPI

Greenville Health Corporation

  • Pharmacy
  • Greenville, SC
National Provider Identifier
1508816802
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
10-02663 Issued in SC
Legal business name
GREENVILLE HEALTH CORPORATION
Practice address
701 Grove Rd
Employee Pavilion
Greenville, SC 29605-5611
Phone
(864) 455-8910
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Polly H. Miller
Title
VP Payor Strategies & Alignment
Phone
(864) 522-2286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 10-02663 SC Primary

Addresses

Primary practice location

701 Grove Rd
Employee Pavilion
Greenville, SC 29605-5611

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 455-7000

Other identifiers 3

IdentifierTypeStateIssuer
DE1459MedicaidSC
4217801OtherSCNABP #
726635MedicaidSC

Other names 1

  • Upstate Medical Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160711002087 SC DME Supplier - Pharmacy 4789644212 Practice locations: Greenville, SC
O20160805000436 SC Part B Supplier - Mass Immunization (Roster Biller Only) 4789644212 3 other NPIs on this enrollment
Practice locations: Greenville, SC; Greer, SC

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Upstate Medical Pharmacy701 Grove Rd, Greenville, SC 29605-4210(864) 455-8910 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Jan 1, 2005

National Provider Directory

National Provider Directory
Tax ID family
Urgent Treatment Ctr WH24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1508816802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-455-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "address_2": "EMPLOYEE PAVILION",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296055611",
            "telephone_number": "864-455-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2023-03-07",
        "certification_date": "2021-04-14",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "VP PAYOR STRATEGIES & ALIGNMENT",
        "authorized_official_telephone_number": "864-522-2286"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "SC",
            "license": "10-02663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE1459",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP #",
            "identifier": "4217801",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "726635",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upstate Medical Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Upstate Medical Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.