NPIMap

Organization Active NPI

Welscare of South Carolina, LLC

  • Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1679250146
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
WELSCARE OF SOUTH CAROLINA, LLC
Practice address
111 Lovett Dr
Greenville, SC 29607-6510
Phone
(801) 869-4100
Fax
(208) 869-4119
NPI assigned
Jun 28, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Authorized official

Name
Brad Liljenquist
Title
Owner
Phone
(801) 420-2516

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

111 Lovett Dr
Greenville, SC 29607-6510

Mailing address

1250 E 3900 S Ste 440
Salt Lake City, UT 84124-1349
Phone (801) 869-4100

Other practice location 1

103 Harth Pl Ste A
Summerville, SC 29485-8107
Phone (801) 869-4100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230824003620 SC Part B Supplier - Clinic/Group Practice 1052774957 Receives reassigned benefits from 17 practitioners
Practice locations: Greenville, SC; Summerville, SC

National Provider Directory

National Provider Directory

Locations

111 Lovett Dr
Greenville, SC 29607
Phone (864) 234-1150

103 Harth Pl
Summerville, SC 29485
Phone (843) 853-5859

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1679250146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 E 3900 S STE 440",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241349",
            "telephone_number": "801-869-4100",
            "fax_number": "801-869-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LOVETT DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296076510",
            "telephone_number": "801-869-4100",
            "fax_number": "208-869-4119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 Harth Pl Ste A",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294858107",
            "country_code": "US",
            "telephone_number": "801-869-4100",
            "fax_number": "801-869-4119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WELSCARE OF SOUTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-28",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "LILJENQUIST",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-420-2516"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "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 Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.