Individual provider Active NPI

Ansley Lauren Speaks, PA-C

  • Physician Assistant
  • Greenville, SC
National Provider Identifier
1568199099
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4516 Issued in SC
Practice address
1005 Grove Rd
Greenville, SC 29605-4630
Phone
(864) 455-6900
Fax
(864) 255-5619
NPI assigned
Aug 4, 2022
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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 4516 SC Primary

Addresses

Primary practice location

1005 Grove Rd
Greenville, SC 29605-4630

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 695-6294

Other practice location 1

102 Ravenwood Ln
Simpsonville, SC 29681-4725
Phone (864) 395-7893

Other practice location 2

111 Doctors Dr
Greenville, SC 29605-5622
Phone (864) 797-7060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240314000873 SC Practitioner - Physician Assistant 2163868068 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4516SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Feb 5, 2024 Accepting new patients
Prisma Health University Medical Group CurrentSince Feb 5, 2024 Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

111 Doctors Dr
Greenville, SC 29605
Phone (864) 242-4683

1005 Grove Rd
Greenville, SC 29605
Phone (864) 235-7665

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1568199099",
    "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": "864-695-6294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054630",
            "telephone_number": "864-455-6900",
            "fax_number": "864-255-5619"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Ravenwood Ln",
            "address_purpose": "LOCATION",
            "city": "Simpsonville",
            "state": "SC",
            "postal_code": "296814725",
            "country_code": "US",
            "telephone_number": "864-395-7893",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Doctors Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296055622",
            "country_code": "US",
            "telephone_number": "864-797-7060",
            "fax_number": "864-797-7065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPEAKS",
        "first_name": "ANSLEY",
        "middle_name": "LAUREN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-04",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.