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Organization Active NPI

Prisma Health University Medical Group

Doing business as PH Developmental Pediatrics

  • Developmental - Behavioral Pediatrics Physician
  • Greenville, SC
National Provider Identifier
1578890273
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Doing business as
PH Developmental Pediatrics
Practice address
200 Patewood Dr
Suite A200
Greenville, SC 29615-3593
Phone
(864) 454-5115
NPI assigned
Nov 17, 2009
Last updated
Feb 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Authorized official

Name
Kristi Ann Lawrence
Title
Director Provider Enrollment & Cvo
Phone
(864) 522-8611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics Physician 2080P0006X NU Primary

Addresses

Primary practice location

200 Patewood Dr
Suite A200
Greenville, SC 29615-3593

Mailing address

7 Independence PT Ste 140
Greenville, SC 29615-4550
Phone (864) 385-4790

Other identifiers 3

IdentifierTypeStateIssuer
20032744OtherSCSELECT HEALTH ID NUMBER
DRC010MedicaidSC
DEC300MedicaidSC

Other names 1

  • PH Developmental Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
GHS Partners in Health Inc34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1578890273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 INDEPENDENCE PT STE 140",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154550",
            "telephone_number": "864-385-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "SUITE A200",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH UNIVERSITY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-17",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR PROVIDER ENROLLMENT & CVO",
        "authorized_official_telephone_number": "864-522-8611"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT HEALTH ID NUMBER",
            "identifier": "20032744",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DRC010",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DEC300",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PH Developmental Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 23, 2024; 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.