NPIMap

Individual provider Active NPI

Alexandra Nicole Mycock, PA-C

  • Physician Assistant
  • Greenville, SC
National Provider Identifier
1679288534
Registry record updated Jan 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4805 Issued in SC
Practice address
890 W Faris Rd Ste 100
Greenville, SC 29605-4285
Phone
(864) 455-2888
Fax
(864) 455-2885
NPI assigned
Jan 16, 2023
Last updated
Jan 14, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA4805 SC
Physician Assistant 363A00000X 4805 SC Primary

Addresses

Primary practice location

890 W Faris Rd Ste 100
Greenville, SC 29605-4285

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-2603

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
I20231101002419 SC Practitioner - Physician Assistant 2163878869 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

210 Freeman Farm Rd
Duncan, SC 29334-9398
Phone (864) 968-5123

701 Grove Rd
Greenville, SC 29605-4210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4805SCMDOccupational Therapy Assistant
PA4805SCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Sep 22, 2025 Accepting new patients
Commonwealth Pain Associates PLLC CurrentSince Feb 1, 2025 Accepting new patients
Commonwealth Pain Associates, PLLC Physician Assistant CurrentSince Feb 1, 2025 Accepting new patients
Carolinas Center for Advanced Management of Pain, LLC CurrentSince Sep 18, 2023 Accepting new patients
Prisma Health University Medical Group Past Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

10 Enterprise Blvd
Ste 201
Greenville, SC 29615
Phone (864) 234-7815

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

300 E McBee Ave
Ste 300
Greenville, SC 29601

279 E Kennedy St
Spartanburg, SC 29302
Phone (864) 583-0053

Interoperability endpoints

  • Direct secure messaging: amycock880939@direct.ghs.myhfn.org

Organizations & group practices 5

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 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768348800000",
    "number": "1679288534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-2603",
            "fax_number": "864-455-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 W FARIS RD STE 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054285",
            "telephone_number": "864-455-2888",
            "fax_number": "864-455-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYCOCK",
        "first_name": "ALEXANDRA",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-16",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "PA4805",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.