NPIMap

Individual provider Active NPI

Manuel A Dorna-Pesquera, MD

  • Family Medicine Physician
  • Greenville, SC
National Provider Identifier
1689650376
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19414 Issued in SC
Practice address
135 Commonwealth Dr. Ste. 100
Greenville, SC 29615-6940
Phone
(864) 263-4444
Fax
(864) 263-4445
NPI assigned
Dec 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19414 SC Primary

Addresses

Primary practice location

135 Commonwealth Dr. Ste. 100
Greenville, SC 29615-6940

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other practice location 1

120 Heywood Ave Ste 200
Spartanburg, SC 29302-1210
Phone (864) 573-9595

Other identifiers 2

IdentifierTypeStateIssuer
194140MedicaidSC
P01195502OtherSCRAILROAD MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mdornapesquera8458@direct-srhs.et0939.epichosted.com Direct

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
I20110104000932 SC Practitioner - Family Practice 7618015603 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University Central del Caribe Escuela de Medicina, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, shared by 17 NPIs, 1,060 clinicians

Practice addresses (Care Compare)

120 Heywood Ave
Suite 200
Spartanburg, SC 29302-1210
Phone (864) 573-9595

2660 Reidville Rd
Unit 1
Spartanburg, SC 29301-3512
Phone (864) 560-9696

2995 Reidville Rd
Suite 100
Spartanburg, SC 29301-5600
Phone (864) 587-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Family Medicine Current Accepting new patients
Spartanburg Medical Center CurrentSince Jul 10, 2012 Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Jul 10, 2012 Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Oct 1, 2018 Accepting new patients
Cherokee Medical Center Family Medicine CurrentSince Dec 1, 2021 Accepting new patients
Cherokee Medical Center CurrentSince Dec 1, 2021 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Dec 1, 2021 Accepting new patients
Boiling Springs Family Medicine Family Medicine Current Accepting new patients
Spartanburg Medical Center Past Accepting new patients
St Francis Physician Services Inc Family Medicine Past Accepting new patients

Locations

840 W Floyd Baker Blvd
Gaffney, SC 29341
Phone (864) 489-3300

12230 Asheville Hwy
Inman, SC 29349
Phone (864) 472-2144

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

120 Heywood Ave
Ste 200
Spartanburg, SC 29302
Phone (864) 560-3800

2660 Reidville Rd
Unit 1
Spartanburg, SC 29301
Phone (864) 560-9696

2995 Reidville Rd
Ste 100
Spartanburg, SC 29301
Phone (864) 587-3000

2306 Chesnee Hwy
Ste 10
Spartanburg, SC 29303
Phone (864) 542-8522

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

511 Cross Anchor Rd
Woodruff, SC 29388
Phone (864) 278-6031

Interoperability endpoints

  • Direct secure messaging: mdornapesquera8458@direct-srhs.et0939.epichosted.com

Organizations & group practices 11

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1689650376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 COMMONWEALTH DR. STE. 100",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156940",
            "telephone_number": "864-263-4444",
            "fax_number": "864-263-4445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Heywood Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293021210",
            "country_code": "US",
            "telephone_number": "864-573-9595",
            "fax_number": "864-560-3850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DORNA-PESQUERA",
        "first_name": "MANUEL",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "19414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194140",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01195502",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdornapesquera8458@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mdornapesquera8458@direct-srhs.et0939.epichosted.com",
            "address_1": "120 Heywood Ave Ste 200",
            "city": "Spartanburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293021210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.