NPIMap

Organization Active NPI

Palmetto Health

Doing business as Clemson Neurology

  • Neurology Physician
  • Clemson, SC
National Provider Identifier
1710137047
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
PALMETTO HEALTH
Doing business as
Clemson Neurology
Practice address
220 Keowee TRL
Clemson, SC 29631-1448
Phone
(864) 653-4071
Fax
(864) 653-4074
NPI assigned
Sep 23, 2008
Last updated
Sep 23, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PALMETTO HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

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

Authorized official

Name
Ms. Kendall Durham
Title
Office Manager
Phone
(864) 855-5104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X SC Primary

Addresses

Primary practice location

220 Keowee TRL
Clemson, SC 29631-1448

Mailing address

220 Keowee TRL
Clemson, SC 29631-1448
Phone (864) 653-4071

Other names 1

  • Clemson Neurology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000506 SC Part B Supplier - Clinic/Group Practice 6800708330 Receives reassigned benefits from 364 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Columbia, SC

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory
Part of
Northeast Family Practi

NPI Registry JSON

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1710137047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 KEOWEE TRL",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296311448",
            "telephone_number": "864-653-4071",
            "fax_number": "864-653-4074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 KEOWEE TRL",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296311448",
            "telephone_number": "864-653-4071",
            "fax_number": "864-653-4074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALMETTO HEALTH",
        "enumeration_date": "2008-09-23",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "DURHAM",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "864-855-5104",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clemson Neurology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clemson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; 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.