NPIMap

Individual provider Active NPI

Sanjana Iddyadinesh, D.O

  • Family Medicine Physician
  • Greenville, SC
National Provider Identifier
1548641871
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
83144 Issued in SC
Practice address
3904 S Highway 14
Greenville, SC 29615-6138
Phone
(864) 987-9990
NPI assigned
Jun 11, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2018-02717 NC
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 83144 SC Primary

Addresses

Primary practice location

3904 S Highway 14
Greenville, SC 29615-6138

Mailing address

3904 S Highway 14
Greenville, SC 29615-6138
Phone (864) 987-9990

Other practice location 1

3402 Battleground Ave
Greensboro, NC 27410-2578
Phone (336) 883-0029

Other identifiers 1

IdentifierTypeStateIssuer
1548641871MedicaidNC

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
I20200706000746 SC Practitioner - Family Practice 1951647916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Francis Physician Services IncGroup PAC ID 6608826821, 106 clinicians

Practice addresses (Care Compare)

1200 Brookfield Blvd
Suite 400B
Greenville, SC 29607-6583
Phone (864) 605-3721

305 Tanner Rd
Greenville, SC 29607-5923
Phone (864) 627-1220

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018-02717NCMDFamily Medicine Physician
83144SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Francis Physician Services Inc Single Specialty CurrentSince Oct 7, 2021 Accepting new patients
St Francis Physician Services Inc Family Medicine CurrentSince Oct 7, 2021 Accepting new patients
St Francis Physician Services Inc Single Specialty Past Accepting new patients

Locations

1200 Brookfield Blvd
Ste 400B
Greenville, SC 29607
Phone (864) 605-3721

3904 S Highway 14
Greenville, SC 29615
Phone (864) 987-9990

305 Tanner Rd
Greenville, SC 29607
Phone (864) 627-1220

Organizations & group practices 3

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

Hospital & facility affiliations 7

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": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1548641871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3904 S HIGHWAY 14",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156138",
            "telephone_number": "864-987-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3904 S HIGHWAY 14",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156138",
            "telephone_number": "864-987-9990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3402 Battleground Ave",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274102578",
            "country_code": "US",
            "telephone_number": "336-883-0029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IDDYADINESH",
        "first_name": "SANJANA",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-11",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2018-02717",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "83144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548641871",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.