Prisma Health-Upstate
Organization Active NPI Rural Health Clinic/Center · Greenville, SC
NPI 1730770744 · NPPES record last updated Feb 24, 2022
Key facts
- NPI
- 1730770744
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PRISMA HEALTH-UPSTATE
- Practice address
- 207 Three Bridges Rd
Greenville, SC 29611-7549 - Phone
- (864) 220-1110
- Fax
- (864) 220-1104
- NPI assigned
- Feb 2, 2021
- Organization subpart
- No
Authorized official
- Name
- Polly H. Miller
- Title
- SVP Finance, Enterprise Contracting
- Phone
- (864) 522-2286
Corporate family (same tax ID) 24
Related certifications (CCN) 4
Facilities with the same owner 26
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Rural health clinic certification: CCN 423491
- Legal name
- PRISMA HEALTH-UPSTATE
- Doing business as
- PH PEDIATRICS-POWDERSVILLE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 16, 2021
- Last certification
- Aug 16, 2021
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 1, 2019 in SC
- Enrollment address
- 207 Three Bridges Rd
Greenville, SC 29611-7549 - Related CCNs
- 420037
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Kristi a Lawrence |
Corporate Director |
Apr 5, 2020 | 100% |
| W-2 Managing Employee |
Apr 5, 2020 | 100% | |
| Polly H Miller |
Corporate Officer |
Mar 20, 2020 | 100% |
| W-2 Managing Employee |
Mar 20, 2020 | 100% | |
| Operational/Managerial Control |
Mar 20, 2020 | 100% | |
| Prisma Health-Upstate |
5% Or Greater Direct Ownership Interest | Apr 1, 2019 | 100% |
All facility ownership & control disclosures 26
| Facility | Type | Role | Since |
|---|---|---|---|
| Prisma Health Hillcrest Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Greer Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Marshall I Pickens |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Roger C Peace Rehabilitation |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Pediatrics Verdae |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Oconee Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Laurens County Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Patewood Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health North Greenville Ltach |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Baptist Easley Hospital O/P Therapy Services |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2018 Oct 1, 2018 |
| Prisma Health Home Health--Upstate |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Hospice of the Foothills |
Hospice | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Apr 1, 2019 Apr 1, 2019 |
| PH Pediatrics-Clemson |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Laurens Family Med-Main |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Apr 1, 2019 Apr 1, 2019 |
| Prisma Health Laurens Family Med-Gray CT |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| PH Pediatrics-Seneca |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| Prisma Health Advanced Family Medicine |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2016 Oct 1, 2016 |
| PH Family Medicine-Walhalla |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| PH Seneca Medical Associates |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| PH Mountain Lakes Family Medicine |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| PH Family & Internal Medicine-Seneca |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| PH Blue Ridge Women'S Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| PH Primary Care Fountain Inn |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| PH Premier Women'S Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| PH Primary Care North Greenville |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| PH Family Medicine-Powdersville |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210316000977 | SC | Part a Provider - Rural Health Clinic | 5698063162 | Practice locations: Greenville, SC |
National Provider Directory
- Tax ID family
- Upstate Affiliate Org
Locations
207 Three Bridges Rd
Greenville, SC 29611
Phone (864) 220-1110
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
207 Three Bridges Rd
Greenville, SC 29611-7549
Mailing address
300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603
Other names
- PH Pediatrics-Powdersville
Other providers in Greenville, SC
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
- Prisma Health-Upstate
All providers in Greenville, SC · Rural Health Clinic/Center in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.