Greenville Endoscopy Center Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

ASF027 Issued in SC

Legal business name

GREENVILLE ENDOSCOPY CENTER INC

Practice address

125 Halton Road
Suite 100
Greenville, SC 29607

Phone

(864) 232-7338

Fax

(864) 239-6645

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

John W Hickey

Title

Executive Director

Phone

(864) 232-7338

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC2 enrollments

Enrollment records 2

Ambulatory surgical center certification: CCN 42C0001105

Legal name

Greenville Endoscopy Center at Halton Road

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

May 18, 2023

Last certification

Apr 21, 2023

Ownership / control type

Proprietary

Facility address

125 Halton Rd Suite 100
Greenville, SC 29607

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Greenville Endoscopy Center Inc

  • Ambulatory Surgical Clinic/Center
  • Greenville, SC
  • NPI 1932204971

  0547229312

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Greenville Endoscopy Center Inc

  • Ambulatory Surgical Clinic/Center
  • Greenville, SC
  • NPI 1932204971

  O20041007000207

  Same enrollment

Listed as

Greenville Endoscopy CenterCCN 42C0001074

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen Paul Brackbill, MD

  • Gastroenterology Physician
  • Greenville, SC
  • NPI 1437190428
  NPD
• Preston Allen Jones Jr., M.D.

  • Gastroenterology Physician
  • Greenville, SC
  • NPI 1821268368
  NPD
• David Timothy Palma, MD

  • Gastroenterology Physician
  • Greenville, SC
  • NPI 1578775854
  NPD (past)
• Teresa Danielle Truman, APRN

  • Family Nurse Practitioner
  • Greenville, SC
  • NPI 1427319847
  NPD (past)
• Hiren Vallabh, M.D.

  • Gastroenterology Physician
  • Frisco, TX
  • NPI 1043539471
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675814400000",
    "number": "1619051760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8555",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296048555",
            "telephone_number": "864-232-7338",
            "fax_number": "864-239-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HALTON ROAD",
            "address_2": "SUITE 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29607",
            "telephone_number": "864-232-7338",
            "fax_number": "864-239-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE ENDOSCOPY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "864-232-7338"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SC",
            "license": "ASF027",
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Greenville Dermatology LLC
• Greenville Diagnostic Imaging, LLC (Novant Health Imaging Patewood)
• Greenville Dialysis Clinic LLC
• Greenville Ear Nose & Throat
• Greenville Endodontics
• Greenville Endoscopy Center Inc
• Greenville Eyecare Associates PA
• Greenville Facial Plastic Surgery, LLC
• Greenville Family Chiropractic
• Greenville Family Smiles, LLC

• Ambulatory Surgical Clinic/Center in Greenville, SC
• Providers in Greenville, SC by specialty
• Ambulatory Surgical Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.