NPIMap

Organization Active NPI

Clemsonseneca Pediatric & Adolescent Medicine, P.a.

  • Pediatrics Physician
  • Seneca, SC
National Provider Identifier
1760547335
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
10252 Issued in SC
Legal business name
CLEMSONSENECA PEDIATRIC & ADOLESCENT MEDICINE, P.A.
Practice address
207 Main St
Seneca, SC 29678-3245
Phone
(864) 888-4222
Fax
(864) 888-0023
NPI assigned
Dec 26, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jordan A Dean Jr., M.D.NPI 1700887189
Title
President
Phone
(864) 888-4222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 10252 SC Primary

Addresses

Primary practice location

207 Main St
Seneca, SC 29678-3245

Mailing address

207 Main St
Seneca, SC 29678-3245
Phone (864) 888-4222

Other identifiers 1

IdentifierTypeStateIssuer
MPA972MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760547335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 MAIN ST",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296783245",
            "telephone_number": "864-888-4222",
            "fax_number": "864-888-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 MAIN ST",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296783245",
            "telephone_number": "864-888-4222",
            "fax_number": "864-888-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMSONSENECA PEDIATRIC & ADOLESCENT MEDICINE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-888-4222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "10252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MPA972",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seneca, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.