SC-Premier Wellness Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SC-PREMIER WELLNESS CARE

Practice address

400 Pendleton Rd
Clemson, SC 29631-2211

Phone

(225) 620-6222

Fax

(864) 722-5319

NPI assigned

Feb 24, 2016

Organization subpart

No

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

Authorized official

Name

Jacque Shadle

Title

Ceo

Phone

(225) 445-0038

Specialties & licenses 1

Addresses

Other names 1

• Premier Wellness Care Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ronande Berryl Creebsburg, NP-C

  • Family Nurse Practitioner
  • Seneca, SC
  • NPI 1225543242
  NPD (past)

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

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1528428299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 PENDLETON RD",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296312211",
            "telephone_number": "864-722-5315",
            "fax_number": "864-722-5319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 PENDLETON RD",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296312211",
            "telephone_number": "225-620-6222",
            "fax_number": "864-722-5319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SC-PREMIER WELLNESS CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-24",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "SHADLE",
        "authorized_official_first_name": "JACQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-445-0038"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Wellness Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan P. Macrae, LLC
• Jake Edward Rydland
• Corrine Rae Sackett, LMFT
• Henry D. Salter III, M.D.
• Nicholas Richard Saul, BS, MSAT
• Derrill Ernest Schumpert III, MD
• Martha Kaye Schumpert, DPT
• Kelli Elliott Scott, PHARMD
• Michelle Grant Scott, MSW, LISW-CP
• Jerry F Sherrill, M.D.

• Family Medicine Physician in Clemson, SC
• Providers in Clemson, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.