NPIMap

Individual provider Active NPI

John Michael Humeniuk, M.D., LLC

  • Procedural Dermatology Physician
  • Greenville, SC
National Provider Identifier
1639164528
Registry record updated Dec 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
10819 Issued in SC
Practice address
21 Memorial Medical Dr
Greenville, SC 29605-4407
Phone
(864) 295-9085
Fax
(864) 295-1075
NPI assigned
Sep 16, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Procedural Dermatology Physician 207NS0135X 10819 SC Primary

Addresses

Primary practice location

21 Memorial Medical Dr
Greenville, SC 29605-4407

Mailing address

21 Memorial Medical Dr
Greenville, SC 29605-4407
Phone (864) 295-9085

Other identifiers 1

IdentifierTypeStateIssuer
108190MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100415000058 SC Practitioner - Dermatology 2062549504 Practice locations: Greenville, SC; Greer, SC; Simpsonville, SC

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

21 Memorial Medical Dr
Greenville, SC 29605-4407
Phone (864) 295-9085

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision62
Removal of tissue1-10
Removal of skin lesions7955
Removal of nail tissue1-10
Removal or shaving of skin growth244
Skin biopsy81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
10819SCMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Epiphany Dermatology of South Carolina LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: johnhumeniuk@jhmd.allscriptsdirect.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 43

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387497600000",
    "number": "1639164528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054407",
            "telephone_number": "864-295-9085",
            "fax_number": "864-295-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054407",
            "telephone_number": "864-295-9085",
            "fax_number": "864-295-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMENIUK",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "credential": "M.D., LLC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2013-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "SC",
            "license": "10819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108190",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.