Individual provider Active NPI

Wayne S Mounts, PAC

  • Physician Assistant
  • Greenwood, SC
National Provider Identifier
1780631879
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
502 Issued in SC
Practice address
115 Academy Ave
Greenwood, SC 29646-3869
Phone
(864) 725-7272
Fax
(864) 725-5799
NPI assigned
May 27, 2006
Last updated
Sep 4, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 502 SC Primary

Addresses

Primary practice location

115 Academy Ave
Greenwood, SC 29646-3869

Mailing address

115 Academy Ave
Greenwood, SC 29646-3869
Phone (864) 725-7272

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wmounts130156@selfregional.direct-ci.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040506000697 SC Practitioner - Physician Assistant 0840289831 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
502SCMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Oct 1, 2013 Accepting new patients
Self Medical Group CurrentSince Oct 1, 2013 Accepting new patients
Lakelands Orthopaedic Clinic Past Accepting new patients
Self Regional Healthcare Past Accepting new patients
South Carolina Em-I Medical Services PC Physician Assistant Past Accepting new patients
Upstate Emergency Physicians LLC Past Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients
Camille Mason MD PA PastSince Jul 1, 2011 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

75 Remittance Dr
Dept 6875
Chicago, IL 60675

102 Gregor Mendel Cir
Greenwood, SC 29646
Phone (864) 229-2663

104 Wells Ave
Greenwood, SC 29646

115 Academy Ave
Greenwood, SC 29646
Phone (864) 725-7272

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: wmounts130156@selfregional.direct-ci.net

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1780631879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 ACADEMY AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463869",
            "telephone_number": "864-725-7272",
            "fax_number": "864-725-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ACADEMY AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463869",
            "telephone_number": "864-725-7272",
            "fax_number": "864-725-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUNTS",
        "first_name": "WAYNE",
        "middle_name": "S",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wmounts130156@selfregional.direct-ci.net",
            "affiliation": "N",
            "address_1": "115 Academy Ave",
            "city": "Greenwood",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296463869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.