Premier Clinics PA

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

19921 Issued in SC

Legal business name

PREMIER CLINICS PA

Doing business as

Premier Clincs

Practice address

120 York St
Chester, SC 29706-1484

Phone

(803) 581-3000

Fax

(803) 581-2997

NPI assigned

Jul 24, 2006

Last updated

Feb 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bamidele A Ekunsanmi, MDNPI 1932156171

Title

President/Ceo

Phone

(803) 581-3000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PREMIER CLINCS Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 4

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.

• Bamidele A Ekunsanmi, M.D

  • Internal Medicine Physician
  • Rock Hill, SC
  • NPI 1932156171
  Medicare reassignment NPD Authorized official
• Kacie Jo Costello Moody, PA

  • Physician Assistant
  • Fort Mill, SC
  • NPI 1841461373
  NPD (past)
• Tolulola Omololu Adeola, MD

  • Hospitalist Physician
  • North Wilkesboro, NC
  • NPI 1578582797

  Internal Medicine

  NPD (past)
• Edwin Aziegbe Avbuere, MD

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1013019470
  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204243200000",
    "number": "1548282452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "address_2": "120 YORK STREET",
            "city": "CHESTER",
            "state": "SC",
            "postal_code": "297060159",
            "telephone_number": "803-581-3000",
            "fax_number": "803-581-2997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 YORK ST",
            "city": "CHESTER",
            "state": "SC",
            "postal_code": "297061484",
            "telephone_number": "803-581-3000",
            "fax_number": "803-581-2997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER CLINICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2008-02-29",
        "status": "A",
        "authorized_official_last_name": "EKUNSANMI",
        "authorized_official_first_name": "BAMIDELE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "803-581-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "SC",
            "license": "19921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3015",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIER CLINCS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alacia Ceondra Pickett, RN
• Jeffrey Thomas Pilcher, PHARMD
• Drewid Plyer Poulos, PA-C
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• Miranda Prisland, RD, LD
• Brenda Raines, R N
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• George Paul Reid, D.M.D.
• Resourceful Health Care

• Primary Care Clinic/Center in Chester, SC
• Providers in Chester, SC by specialty
• Primary Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.