NPIMap

Organization Active NPI

Greenville Kidney Care LLC

  • Nephrology Physician
  • Greenville, SC
National Provider Identifier
1659654002
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
23113 Issued in SC
Legal business name
GREENVILLE KIDNEY CARE LLC
Practice address
29 Memorial Medical Dr
Greenville, SC 29605-4407
Phone
(864) 220-1200
Fax
(864) 220-1888
NPI assigned
Sep 22, 2011
Last updated
Dec 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Hannah Cooley
Title
Office Administrator
Phone
(864) 312-3105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 23113 SC Primary

Addresses

Primary practice location

29 Memorial Medical Dr
Greenville, SC 29605-4407

Mailing address

29 Memorial Medical Dr
Greenville, SC 29605-4407
Phone (864) 220-1200

Other practice location 1

300 Plaza Cir Ste F
Clinton, SC 29325-7557
Phone (864) 220-1200

Other identifiers 1

IdentifierTypeStateIssuer
GP5803MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111129000749 SC Part B Supplier - Clinic/Group Practice 1557535614 Receives reassigned benefits from 8 practitioners
Practice locations: Clinton, SC; Greenville, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0252328Greenville Kidney Care, LLC29 Memorial Medical Drive, Greenville, SC 29605Provider-performed microscopyAug 31, 2026
42D0698004Greenville Kidney Care, LLC300 Plaza Circle, Clinton, SC 29325Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Locations

300 Plaza Cir
Ste F
Clinton, SC 29325
Phone 8642201200 ext. 232

29 Memorial Medical Dr
Greenville, SC 29605
Phone (864) 220-1200

31 Memorial Medical Dr
Greenville, SC 29605
Phone (864) 363-4387

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1659654002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054407",
            "telephone_number": "864-220-1200",
            "fax_number": "864-220-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054407",
            "telephone_number": "864-220-1200",
            "fax_number": "864-220-1888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Plaza Cir Ste F",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "SC",
            "postal_code": "293257557",
            "country_code": "US",
            "telephone_number": "864-220-1200",
            "fax_number": "864-220-1888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREENVILLE KIDNEY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-22",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "COOLEY",
        "authorized_official_first_name": "HANNAH",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "864-312-3105"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "SC",
            "license": "23113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5803",
            "state": "SC"
        }
    ],
    "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 Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.