NPIMap

Individual provider Active NPI

David Wayne Koontz, MD

  • Internal Medicine Physician
  • Greenville, SC
National Provider Identifier
1750366647
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
22464 Issued in SC
Practice address
1025 Verdae Blvd
Suite a
Greenville, SC 29607-4032
Phone
(864) 242-4683
Fax
(864) 240-8104
NPI assigned
Dec 13, 2005
Last updated
Apr 18, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 22464 SC Primary

Addresses

Primary practice location

1025 Verdae Blvd
Suite a
Greenville, SC 29607-4032

Mailing address

1 Independence PT
Suite 212
Greenville, SC 29615-4545
Phone (864) 797-6044

Other identifiers 2

IdentifierTypeStateIssuer
110221760OtherSCRR MEDICARE
224643MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040730000207 SC Practitioner - Internal Medicine 8527038033 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wake Forest University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1025 Verdae Blvd
Suite a
Greenville, SC 29607-4032
Phone (864) 242-4683

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22464SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Jan 1, 2008 Accepting new patients
Prisma Health University Medical Group Internal Medicine CurrentSince Jan 1, 2008 Accepting new patients
Greenville Health System CurrentSince Sep 20, 2008 Accepting new patients
Prisma Health University Medical Group Internal Medicine Current Accepting new patients
Greenville Health System Current Accepting new patients

Locations

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

100 Augusta St
Greenville, SC 29601
Phone (864) 455-2600

1025 Verdae Blvd
#A
Greenville, SC 29607
Phone (864) 242-4683

1025 Verdae Blvd
Ste A
Greenville, SC 29607
Phone (864) 242-4683

1025 Verdae Blvd
Ste D
Greenville, SC 29607
Phone (864) 242-4683

111 Doctors Dr
Greenville, SC 29605
Phone (864) 242-4683

200 Patewood Dr
Bldg A
Greenville, SC 29615
Phone (864) 454-2604

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

315 Medical Pkwy
Ste 200
Greer, SC 29650
Phone (864) 797-9550

719A SE Main St
Simpsonville, SC 29681
Phone (864) 967-9000

807 N Main St
Travelers Rst, SC 29690
Phone (864) 834-5132

Interoperability endpoints

  • Direct secure messaging: dkoontz32199@direct.ghs.myhfn.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 63

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334707200000",
    "number": "1750366647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT",
            "address_2": "SUITE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154545",
            "telephone_number": "864-797-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 VERDAE BLVD",
            "address_2": "SUITE A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296074032",
            "telephone_number": "864-242-4683",
            "fax_number": "864-240-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOONTZ",
        "first_name": "DAVID",
        "middle_name": "WAYNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2012-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "22464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110221760",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "224643",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.