Proactive MD Wi SC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PROACTIVE MD WI SC

Practice address

86 Villa Rd Ste 100
Greenville, SC 29615-3052

Phone

(864) 501-0751

NPI assigned

May 20, 2022

Organization subpart

No

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

Authorized official

Name

Mark Allen Kemble, MD

Title

Chief Medical Officer

Phone

(864) 640-8355

Specialties & licenses 1

Addresses

Other names 1

• Proactive MD Other name

Tax ID family

Proactive MD4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Proactive MD Wi SC

  • Primary Care Clinic/Center
  • Franklin, WI
  • NPI 1790662484
  NPD tax ID
• Proactive MD Wi SC

  • Primary Care Clinic/Center
  • Westfield, WI
  • NPI 1871127092
  NPD tax ID
• Proactive MD Wi SC

  • Primary Care Clinic/Center
  • Waukesha, WI
  • NPI 1932935962
  NPD tax ID

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1619615655",
    "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 MD WI SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Proactive MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Proactive MD Penn PC
• Proactive MD SC,P.a.
• Proactive MD SC,P.a.
• Proactive MD TN PC
• Proactive MD TX Professional Corporation
• Proactive Mso, LLC
• Letty Probasco, MD
• Ronne Justine Proch, DO
• Kate Prochaska
• Professional Health SVC

• Primary Care Clinic/Center in Greenville, SC
• Providers in Greenville, SC by specialty
• Primary Care Clinic/Center in South Carolina

• 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.