NPIMap

Organization Active NPI

Spartanburg Medical Center

Doing business as Medical Group of the Carolinas - Carolina Ob/Gyn

  • Obstetrics & Gynecology Physician
  • Spartanburg, SC
National Provider Identifier
1760637904
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SPARTANBURG MEDICAL CENTER
Doing business as
Medical Group of the Carolinas - Carolina Ob/Gyn
Medical Group of the Carolinas - Carolina Piedmont OB/GYN - East
Practice address
1686 Skylyn Dr
Suite 101
Spartanburg, SC 29307-1079
Phone
(864) 585-3456
Fax
(864) 585-3209
NPI assigned
Dec 1, 2008
Last updated
Jun 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

Name
Bruce A Davis
Title
Chief Financial Officer
Phone
(864) 560-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X Primary

Addresses

Primary practice location

1686 Skylyn Dr
Suite 101
Spartanburg, SC 29307-1079

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other practice location 1

2995 Reidville Rd Ste 290
Spartanburg, SC 29301-5667
Phone (864) 574-4483

Other practice location 2

3941 Highway 9 Ste A
Boiling Springs, SC 29316-8578
Phone (864) 278-1400

Other practice location 3

2801 Woodruff Rd Ste 201
Simpsonville, SC 29681-4807
Phone (864) 849-9466

Other practice location 4

853 N Church St Ste 600
Spartanburg, SC 29303-3070
Phone (864) 583-4556

Other identifiers 5

IdentifierTypeStateIssuer
GP5629MedicaidSC
PG1323MedicaidSC
PG1327MedicaidSC
CN1627OtherSCRR MEDICARE
PG1325MedicaidSC

Other names 2

  • Medical Group of the Carolinas - Carolina Ob/Gyn Doing business as
  • Medical Group of the Carolinas - Carolina Piedmont OB/GYN - East Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040108000827 SC Part B Supplier - Clinic/Group Practice 3072425297 Receives reassigned benefits from 324 practitioners
48 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spartanburg, SC; Union, SC; Simpsonville, SC; Boiling Springs, SC; Gaffney, SC; Greenville, SC; Greer, SC

Other NPIs on the same Medicare enrollment 48

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

View all 48

National Provider Directory

National Provider Directory
Tax ID family
Orthopaedic Surgery Spo136 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

Practitioners & affiliated clinicians

Practitioners 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1228089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1760637904",
    "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": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 SKYLYN DR",
            "address_2": "SUITE 101",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071079",
            "telephone_number": "864-585-3456",
            "fax_number": "864-585-3209"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2995 Reidville Rd Ste 290",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293015667",
            "country_code": "US",
            "telephone_number": "864-574-4483",
            "fax_number": "864-574-1162",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3941 Highway 9 Ste A",
            "address_purpose": "LOCATION",
            "city": "Boiling Springs",
            "state": "SC",
            "postal_code": "293168578",
            "country_code": "US",
            "telephone_number": "864-278-1400",
            "fax_number": "864-278-1418",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 Woodruff Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Simpsonville",
            "state": "SC",
            "postal_code": "296814807",
            "country_code": "US",
            "telephone_number": "864-849-9466",
            "fax_number": "864-849-9166",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "853 N Church St Ste 600",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293033070",
            "country_code": "US",
            "telephone_number": "864-583-4556",
            "fax_number": "864-560-0625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPARTANBURG MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.",
        "enumeration_date": "2008-12-01",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "864-560-6000"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5629",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PG1323",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PG1327",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CN1627",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PG1325",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Group of the Carolinas - Carolina Ob/Gyn",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medical Group of the Carolinas - Carolina Ob/Gyn",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medical Group of the Carolinas - Carolina Piedmont OB/GYN - East",
            "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 Jun 12, 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.