Ps121 Management PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

PS121 MANAGEMENT PA

Doing business as

Vida Gynecology

Practice address

330C Pelham Rd Ste a
Greenville, SC 29615-3111

Phone

(864) 720-1299

Fax

(864) 720-1300

NPI assigned

Jul 26, 2018

Last updated

May 24, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bryanna Wyatt

Title

Office Manager

Phone

(864) 720-1299

Specialties & licenses 1

Addresses

Other names 1

• VIDA GYNECOLOGY Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 7

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.

• Denise Ann Broderick, M.D.

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1942250980
  Medicare reassignment Care Compare group NPD
• Tamela Gail Gallman-Keller, M.D.

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1932137163
  Medicare reassignment Care Compare group NPD
• Elizabeth S. Haswell, MD

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1407040645
  Medicare reassignment Care Compare group NPD
• Kimberly Sue Holloway, M.D.

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1447209374
  Medicare reassignment Care Compare group NPD
• Alexandra Sanders Nicholson, PA-C

  • Physician Assistant
  • Greenville, SC
  • NPI 1922887801
  Medicare reassignment Care Compare group
• Andrea Nicole Wininger, M.D.

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1720023146
  Medicare reassignment NPD
• Georgia Lynn Brady, WHNP

  • Women's Health Nurse Practitioner
  • Aiken, SC
  • NPI 1427765379
  NPD (past)

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1699252163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330C PELHAM RD STE A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153111",
            "telephone_number": "864-720-1299",
            "fax_number": "864-720-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330C PELHAM RD STE A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153111",
            "telephone_number": "864-720-1299",
            "fax_number": "864-720-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PS121 MANAGEMENT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-26",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "BRYANNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "864-720-1299"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VIDA GYNECOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Bate Pruitt, DMD
• Pruitthealth Home Health, Inc. (PruittHealth Home Health - Greenville)
• Kyle L Prusso, DC
• Michelle Pryce, RN
• Jillian H Przybyla, M. ED, CCC-SLP
• PSC Sleep Centers, LLC
• Psgsc MSSP, P.C.
• Susan M Psimer, SCLISW-CP
• Psychiatric Associates PA
• Psychiatric Services Inc.

• Obstetrics & Gynecology Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Obstetrics & Gynecology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; 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.