NPIMap

Organization Active NPI

Spartanburg Medical Center

Doing business as Medical Group of the Carolinas - Internal Medicine - Eastside

  • Internal Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1801206123
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SPARTANBURG MEDICAL CENTER
Doing business as
Medical Group of the Carolinas - Internal Medicine - Eastside
Practice address
1650 Skylyn Dr Ste 220
Spartanburg, SC 29307-1069
Phone
(864) 560-9056
Fax
(864) 560-9057
NPI assigned
May 8, 2014
Last updated
Mar 14, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARTANBURG HEALTH SERVICES DISTRICT, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

1650 Skylyn Dr Ste 220
Spartanburg, SC 29307-1069

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
GP6478MedicaidSC
5019OtherSCMEDICARE PIN

Other names 1

  • Medical Group of the Carolinas - Internal Medicine - Eastside Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040702000686 SC Part B Supplier - Clinic/Group Practice 3072425297 Receives reassigned benefits from 808 practitioners
45 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spartanburg, SC; Greer, SC; Travelers Rest, SC; Union, SC; Whitmire, SC; Drayton, SC; Gaffney, SC; Gray Court, SC…

Other NPIs on the same Medicare enrollment 45

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

View all 45

National Provider Directory

National Provider Directory
Tax ID family
Wellford Family Medicine136 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

Locations

118 Dillon Dr
Spartanburg, SC 29307
Phone (864) 560-9056

118 Dillon Dr
Ste 101
Spartanburg, SC 29307

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1399507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1801206123",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 SKYLYN DR STE 220",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071069",
            "telephone_number": "864-560-9056",
            "fax_number": "864-560-9057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARTANBURG  HEALTH SERVICES DISTRICT, INC",
        "enumeration_date": "2014-05-08",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SYSTEMS CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "864-560-6000"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6478",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "5019",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Group of the Carolinas - Internal Medicine - Eastside",
            "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 Mar 14, 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.