Individual provider Active NPI

Marisa Ferguson, DPT

  • Physical Therapist
  • Greenville, SC
National Provider Identifier
1578178596
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12857 Issued in CT
Practice address
200 Patewood Dr Ste C150
Greenville, SC 29615-6323
Phone
(864) 454-0904
Fax
(864) 454-0905
NPI assigned
Sep 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 12857 CT Primary

Addresses

Primary practice location

200 Patewood Dr Ste C150
Greenville, SC 29615-6323

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other practice location 1

292 Spielman Hwy
Burlington, CT 06013-1727
Phone (860) 404-2924

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230717001903 SC Practitioner - Physical Therapist in Private Practice 5193135762 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greenville Proaxis Therapy LLCGroup PAC ID 0244267771, 221 clinicians

Practice addresses (Care Compare)

200 Patewood Dr
Suite C250
Greenville, SC 29615-3593
Phone (864) 454-0952

Merit-based Incentive Payment System (MIPS)

Final score
87.01 of 100Reported as group
Quality
90
Improvement activities
40
Cost
75.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12857CTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Greenville Proaxis Therapy, LLC Physical Therapist CurrentSince Jul 24, 2023 Accepting new patients
Greenville Proaxis Therapy LLC CurrentSince Jul 24, 2023 Accepting new patients
Community Physical Therapy Physical Therapist PastSince Sep 20, 2020 Accepting new patients
Prisma Health University Medical Group Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33205 Collection Ctr Dr
Chicago, IL 60693

103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753

2400 N Pleasantburg Dr
Ste D
Greenville, SC 29609
Phone (864) 268-9040

200 Patewood Dr
#C250
Greenville, SC 29615

200 Patewood Dr
Ste C150
Greenville, SC 29615
Phone (864) 454-0904

200 Patewood Dr
Ste C250
Greenville, SC 29615
Phone (864) 454-0952

315 Medical Pkwy
Ste 150
Greer, SC 29650
Phone (864) 695-1418

333 S Pine St
Spartanburg, SC 29302
Phone (864) 515-7500

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1578178596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR STE C150",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156323",
            "telephone_number": "864-454-0904",
            "fax_number": "864-454-0905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "292 Spielman Hwy",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "CT",
            "postal_code": "060131727",
            "country_code": "US",
            "telephone_number": "860-404-2924",
            "fax_number": "860-404-2933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "MARISA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-15",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "12857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 31, 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.