NPIMap

Individual provider Active NPI

Lynwood Breeden Hollis Jr., M.D.

  • Physical Medicine & Rehabilitation Physician
  • Greenville, SC
National Provider Identifier
1649237793
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
16471 Issued in SC
Practice address
35 International Dr
Greenville, SC 29615-4816
Phone
(864) 234-7654
Fax
(864) 675-1657
NPI assigned
May 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 16471 SC
Physical Medicine & Rehabilitation Physician 208100000X 16471 SC Primary

Addresses

Primary practice location

35 International Dr
Greenville, SC 29615-4816

Mailing address

35 International Dr
Greenville, SC 29615-4816
Phone (864) 234-7654

Other identifiers 2

IdentifierTypeStateIssuer
8157OtherSCMEDICARE PTAN
164716MedicaidSC

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
I20050120000761 SC Practitioner - Physical Medicine and Rehabilitation 4082663638 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Medical University of South Carolina College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1050 Grove Rd
Greenville, SC 29605-4649
Phone (864) 234-7654

317 Saint Francis Dr
Suite 220
Greenville, SC 29601-3976
Phone (864) 255-1901

35 International Dr
Greenville, SC 29615-4816
Phone (864) 513-1136

406 N Poinsett Hwy
Travelers Rest, SC 29690-1667
Phone (864) 234-7654

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16471SCMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Francis Physician Services Inc CurrentSince Sep 1, 2006 Accepting new patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 21, 2022 Accepting new patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 21, 2022 Accepting new patients
St Francis Physician Services Inc CurrentSince Sep 1, 2006 Accepting new patients
Neurology Assoc of Greenville PastSince Aug 1, 2001 Accepting new patients
St Francis Physician Services Inc Past Accepting new patients

Locations

1050 Grove Rd
Greenville, SC 29605
Phone (864) 242-5020

125 Commonwealth Dr
Greenville, SC 29615
Phone (864) 225-1800

1 Saint Francis Dr
Greenville, SC 29601
Phone (864) 225-1000

1200 Brookfield Blvd
Ste 400B
Greenville, SC 29607
Phone (864) 605-3721

317 Saint Francis Dr
Ste 220
Greenville, SC 29601
Phone (864) 255-1901

35 International Dr
Greenville, SC 29615
Phone (864) 242-5020

Interoperability endpoints

  • Direct secure messaging: lhollis1152041@direct.bsmhealth.org
  • Direct secure messaging: lhollis@poa1920.srs-direct.com

Organizations & group practices 6

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

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1649237793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 INTERNATIONAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154816",
            "telephone_number": "864-234-7654",
            "fax_number": "864-675-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 INTERNATIONAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154816",
            "telephone_number": "864-234-7654",
            "fax_number": "864-675-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIS",
        "first_name": "LYNWOOD",
        "middle_name": "BREEDEN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "SC",
            "license": "16471",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "SC",
            "license": "16471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "8157",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164716",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.