NPIMap

Organization Active NPI

Clemson/Seneca Pediatrics and Adolescent Medicine, P.a.

  • Pediatrics Physician
  • Seneca, SC
National Provider Identifier
1821090689
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
10252 Issued in SC
Legal business name
CLEMSON/SENECA PEDIATRICS AND ADOLESCENT MEDICINE, P.A.
Practice address
207 Main St
Seneca, SC 29678-3245
Phone
(864) 888-4222
Fax
(864) 888-0023
NPI assigned
Aug 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Lisa Crane, C.N.A.
Title
Insurance Manager
Phone
(864) 888-4222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 10252 SC Primary

Addresses

Primary practice location

207 Main St
Seneca, SC 29678-3245

Mailing address

207 Main St
Seneca, SC 29678-3245
Phone (864) 888-4222

Other identifiers 1

IdentifierTypeStateIssuer
RHC115MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821090689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 MAIN ST",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296783245",
            "telephone_number": "864-888-4222",
            "fax_number": "864-888-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 MAIN ST",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296783245",
            "telephone_number": "864-888-4222",
            "fax_number": "864-888-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMSON/SENECA PEDIATRICS AND ADOLESCENT MEDICINE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRANE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "864-888-4222",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.N.A."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "10252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC115",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seneca, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.