NPIMap

Organization Active NPI

Proactive Mso, LLC

  • Primary Care Clinic/Center
  • Greenville, SC
National Provider Identifier
1619551744
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PROACTIVE MSO, LLC
Practice address
86 Villa Rd Ste 100
Greenville, SC 29615-3052
Phone
(864) 501-0751
NPI assigned
May 5, 2021
Last updated
Aug 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

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

Authorized official

Name
Mark Allen Kemble, MDNPI 1457389637
Title
Chief Medical Officer
Phone
(864) 640-8355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

86 Villa Rd Ste 100
Greenville, SC 29615-3052

Mailing address

86 Villa Rd Ste 100
Greenville, SC 29615-3052
Phone (864) 640-8355

Other practice location 1

124 Allawood Ct
Simpsonville, SC 29681-6207
Phone (864) 501-0751

National Provider Directory

National Provider Directory
Tax ID family
W Lafayette Health Center35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1619551744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 VILLA RD STE 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153052",
            "telephone_number": "864-640-8355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 VILLA RD STE 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153052",
            "telephone_number": "864-501-0751"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "124 Allawood Ct",
            "address_purpose": "LOCATION",
            "city": "Simpsonville",
            "state": "SC",
            "postal_code": "296816207",
            "country_code": "US",
            "telephone_number": "864-501-0751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROACTIVE MSO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-05",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "KEMBLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "864-640-8355",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "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 Aug 24, 2026; 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.