NPIMap

Organization Active NPI

Bountyland Medical Center LLC

  • Chiropractor
  • Seneca, SC
National Provider Identifier
1689779688
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
719 Issued in SC
Legal business name
BOUNTYLAND MEDICAL CENTER LLC
Practice address
1741 Blue Ridge Blvd
Seneca, SC 29672-6613
Phone
(864) 882-6395
Fax
(864) 882-9248
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Authorized official

Name
Dr. Paul R Johnson Jr., DONPI 1861405052
Title
Owner-Chiropractor
Phone
(864) 882-6395

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 719 SC Primary

Addresses

Primary practice location

1741 Blue Ridge Blvd
Seneca, SC 29672-6613

Mailing address

1741 Blue Ridge Blvd
Seneca, SC 29672-6613
Phone (864) 882-6395

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507000398 SC Part B Supplier - Clinic/Group Practice 3072502848 Receives reassigned benefits from 1 practitioner
Practice locations: Seneca, SC

National Provider Directory

National Provider Directory

Locations

1741 Blue Ridge Blvd
Seneca, SC 29672
Phone (864) 882-6395

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537920000000",
    "number": "1689779688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1741 BLUE RIDGE BLVD",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296726613",
            "telephone_number": "864-882-6395",
            "fax_number": "864-882-9248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1741 BLUE RIDGE BLVD",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296726613",
            "telephone_number": "864-882-6395",
            "fax_number": "864-882-9248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNTYLAND MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2018-09-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER-CHIROPRACTOR",
        "authorized_official_telephone_number": "864-882-6395",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seneca, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; 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.