NPIMap

Organization Active NPI

Prisma Health University Medical Group

Doing business as Eastside Pediatrics, PA

  • Pediatrics Physician
  • Taylors, SC
National Provider Identifier
1801524392
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PRISMA HEALTH UNIVERSITY MEDICAL GROUP
Doing business as
Eastside Pediatrics, PA
Practice address
4501 Old Spartanburg Rd Ste 9
Taylors, SC 29687-4105
Phone
(864) 292-8868
Fax
(864) 268-9564
NPI assigned
Aug 11, 2022
Last updated
Aug 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Authorized official

Name
Kristi Ann Lawrence
Title
Director
Phone
(864) 522-8611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

4501 Old Spartanburg Rd Ste 9
Taylors, SC 29687-4105

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842

Other identifiers 1

IdentifierTypeStateIssuer
GP0576MedicaidSC

Other names 1

  • Eastside Pediatrics, PA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000238 SC Part B Supplier - Clinic/Group Practice 8325950983 Receives reassigned benefits from 3,477 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
GHS Partners in Health Inc34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

Practitioners & affiliated clinicians

Practitioners 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1801524392",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 OLD SPARTANBURG RD STE 9",
            "city": "TAYLORS",
            "state": "SC",
            "postal_code": "296874105",
            "telephone_number": "864-292-8868",
            "fax_number": "864-268-9564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH UNIVERSITY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "864-522-8611"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0576",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Pediatrics, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Taylors, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; 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.