Active NPI
Piedmont Comprehensive Pain Management Group LLC
- Interventional Pain Medicine Physician
- Anderson, SC
National Provider Identifier
1609815562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- License
- 19467
- Legal business name
- PIEDMONT COMPREHENSIVE PAIN MANAGEMENT GROUP LLC
- Practice address
- 100 Healthy Way
Suite 1260
Anderson, SC 29621 - Phone
- (864) 225-3551
- Fax
- (864) 328-0328
- NPI assigned
- Jun 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Genna Lynn
- Title
- Office Manager
- Phone
- (864) 269-4416
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine Physician | 208VP0000X | 19980 | SC | |
| Interventional Pain Medicine Physician | 208VP0014X | 19467 | SC | Primary |
| Interventional Pain Medicine Physician | 208VP0014X | 20828 | SC | |
| Interventional Pain Medicine Physician | 208VP0014X | 28639 | SC | |
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
100 Healthy Way
Suite 1260
Anderson, SC 29621
Mailing address
100 Healthy Way
Suite 1260
Anderson, SC 29621-2067
Phone (864) 225-3551
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP2340 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100618000086 | SC | Part B Supplier - Clinic/Group Practice | 7012920945 |
Receives reassigned benefits from 9 practitioners 1 other NPI on this enrollment Practice locations: Anderson, SC; Greenville, SC |
| O20140325001262 | SC | DME Supplier - Physician - General Practice | 7012920945 | Practice locations: Anderson, SC |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Interventional Pain Medicine Physician
- Greenville, SC
- NPI 1295159705
O20100618000086
National Provider Directory
National Provider DirectoryLocations
100 Healthy Way
Ste 1260
Anderson, SC 29621
Phone (864) 225-3551
Practitioners & affiliated clinicians
Practitioners 9
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pain Medicine (Physical Medicine & Rehabilitation) Physician
- Greenville, SC
- NPI 1497796916
Interventional Pain Medicine, SC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1532908800000",
"number": "1609815562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 HEALTHY WAY",
"address_2": "SUITE 1260",
"city": "ANDERSON",
"state": "SC",
"postal_code": "296212067",
"telephone_number": "864-225-3551",
"fax_number": "864-328-0328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 HEALTHY WAY",
"address_2": "SUITE 1260",
"city": "ANDERSON",
"state": "SC",
"postal_code": "29621",
"telephone_number": "864-225-3551",
"fax_number": "864-328-0328"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PIEDMONT COMPREHENSIVE PAIN MANAGEMENT GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-06",
"last_updated": "2018-07-30",
"status": "A",
"authorized_official_last_name": "LYNN",
"authorized_official_first_name": "GENNA",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "864-269-4416"
},
"taxonomies": [
{
"code": "208VP0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Pain Medicine",
"state": "SC",
"license": "19980",
"primary": false
},
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "SC",
"license": "19467",
"primary": true
},
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "SC",
"license": "20828",
"primary": false
},
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "SC",
"license": "28639",
"primary": false
},
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP2340",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anderson, SC
- Diane Piccioni
- Michelle Lewis Pickens
- John Ryan Picoulas, PHARM D
- Piedmont Childrens Clinic
- Piedmont Comprehensive Pain Management
- Piedmont Dental Center-Anderson, P.C
- Piedmont Neurology of the Upstate, PA
- Piedmont Pathology Associates PA
- Piedmont Spine and Neurosurgical Group, P.a.
- Piedmont Surgical Associates PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; 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.