NPIMap

Organization Active NPI

Prisma Health-Upstate

Doing business as Prisma Health Baptist Easley Hospital O/P Services, MCP

  • General Acute Care Hospital
  • Greenville, SC
National Provider Identifier
1790264497
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PRISMA HEALTH-UPSTATE
Doing business as
Prisma Health Baptist Easley Hospital O/P Services, MCP
Practice address
11404 Anderson Rd
Greenville, SC 29611
Phone
(864) 295-7520
NPI assigned
Aug 13, 2018
Last updated
Dec 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Polly H. Miller
Title
SVP Finance, Enterprise Contracting
Phone
(864) 522-2286

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

11404 Anderson Rd
Greenville, SC 29611

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 455-7000

Other names 1

  • Prisma Health Baptist Easley Hospital O/P Services, MCP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181126001379 SC Part A Provider - Hospital 5698063162 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, SC; Easley, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790264497. Details of each certification follow.

Hospital certification: CCN 420015

Legal name
PRISMA HEALTH-UPSTATE
Doing business as
PRISMA HEALTH BAPTIST EASLEY HOSPITAL O/P THERAPY SERVICES
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 13, 2021
Beds
109
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 2018 (4 total)
Organization structure
OtherNon-profit
Incorporated
Apr 1, 2019 in SC
Enrollment address
200 Fleetwood Dr
Easley, SC 29640-2022
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Prisma Health Baptist Easley HospitalCCN 420015 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2050992Prisma Health Baptist Easley Hospital O/P Services11404 Anderson Road Suite B, Greenville, SC 29611AccreditationMay 7, 2027

National Provider Directory

National Provider Directory

Locations

11404 Anderson Rd
Greenville, SC 29611
Phone (864) 295-7500

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristi a Lawrence Individual Corporate DirectorDirector, Provider Enrollment & Cvo Apr 5, 2020 100%
W-2 Managing Employee Apr 5, 2020
Polly H Miller Individual Corporate OfficerSVP Finance, Enterprise Contracting Mar 20, 2020 100%
W-2 Managing Employee Mar 20, 2020
Operational/Managerial Control Mar 20, 2020
Prisma Health-Upstate Organization, Greenville, SC 5% Or Greater Direct Ownership Interest Oct 1, 2018 100%
Operational/Managerial Control Oct 1, 2018 100%

Practitioners & affiliated clinicians

Affiliated clinicians 584

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 584

NPI Registry JSON

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1790264497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-455-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11404 ANDERSON RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29611",
            "telephone_number": "864-295-7520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH-UPSTATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "SVP FINANCE, ENTERPRISE CONTRACTING",
        "authorized_official_telephone_number": "864-522-2286"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prisma Health Baptist Easley Hospital O/P Services, MCP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.