NPIMap

Organization Active NPI

Spartanburg Medical Center

  • Pediatric Critical Care Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1720182116
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
Legal business name
SPARTANBURG MEDICAL CENTER
Practice address
101 E Wood St
Suite 401, 4 Center
Spartanburg, SC 29303-3040
Phone
(864) 560-4304
Fax
(864) 560-4413
NPI assigned
Sep 7, 2006
Organization subpart
Yes
Parent organization
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Authorized official

Name
Kenneth Meinke
Title
Chief Fiancial Officer
Phone
(864) 560-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0203X Primary

Addresses

Primary practice location

101 E Wood St
Suite 401, 4 Center
Spartanburg, SC 29303-3040

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4057

Other identifiers 1

IdentifierTypeStateIssuer
GP1118MedicaidSC

Other names 1

  • Medical Group of the Carolinas - Pediatric Critical Care - Spartanburg Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000129 SC Part B Supplier - Clinic/Group Practice 3072425297 Receives reassigned benefits from 806 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spartanburg, SC; Union, SC; Boiling Springs, SC; Lyman, SC; Greer, SC; Greenville, SC; Gaffney, SC; Duncan, SC…

Other NPIs on the same Medicare enrollment 28

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

View all 28

National Provider Directory

National Provider Directory
Tax ID family
SRMC Subacute Care Phys136 organizations share this tax ID, including this one
Part of
Spartanburg Regional Health Services District Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

101 E Wood St
#401
Spartanburg, SC 29303
Phone (864) 560-6816

Practitioners & affiliated clinicians

Practitioners 3

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": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1720182116",
    "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": "864-560-4057",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E WOOD ST",
            "address_2": "SUITE 401, 4 CENTER",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033040",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC",
        "enumeration_date": "2006-09-07",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "MEINKE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CHIEF FIANCIAL OFFICER",
        "authorized_official_telephone_number": "864-560-6000"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1118",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Group of the Carolinas - Pediatric Critical Care - Spartanburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.