NPIMap

Individual provider Active NPI

Kevin R Rust, MD

  • Otolaryngology Physician
  • Greenwood, SC
National Provider Identifier
1821172560
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
18311 Issued in SC
Practice address
1015 Spring St
Greenwood, SC 29646
Phone
(864) 227-6741
Fax
(864) 227-2026
NPI assigned
Oct 25, 2006
Last updated
Jul 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 18311 SC Primary

Addresses

Primary practice location

1015 Spring St
Greenwood, SC 29646

Mailing address

1015 Spring St
Greenwood, SC 29646
Phone (864) 227-6741

Other identifiers 1

IdentifierTypeStateIssuer
PA1122MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111011000033 SC Practitioner - Otolaryngology 8921176454 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of North Carolina at Chapel Hill School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians
Self Regional HealthcareGroup PAC ID 4082527742, 159 clinicians

Practice addresses (Care Compare)

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

155 Academy Ave
Greenwood, SC 29646-3869
Phone (864) 725-4865

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

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

Merit-based Incentive Payment System (MIPS)

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
18311SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Aug 1, 2024 Accepting new patients
Self Regional Healthcare CurrentSince Feb 2, 2026 Accepting new patients
Self Regional Healthcare CurrentSince Feb 2, 2026 Accepting new patients
Self Medical Group CurrentSince Aug 1, 2024 Accepting new patients
Greenwood Ear Nose and Throat Assoc PA Otolaryngology CurrentSince Jul 15, 1996 Accepting new patients
Self Medical Group Current Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

75 Remittance Dr
Dept 6793
Chicago, IL 60675

200 Carwellyn Rd
Abbeville, SC 29620
Phone (803) 224-7577

1015 Spring St
Greenwood, SC 29646
Phone (864) 227-6741

104 Wells Ave
Greenwood, SC 29646

155 Academy Ave
Greenwood, SC 29646
Phone (864) 725-4865

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

2605 Kinard St
Ste 200B
Newberry, SC 29108

Interoperability endpoints

  • Direct secure messaging: krust54472@selfregional.direct-ci.net

Organizations & group practices 7

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1821172560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "29646",
            "telephone_number": "864-227-6741",
            "fax_number": "864-227-2026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "29646",
            "telephone_number": "864-227-6741",
            "fax_number": "864-227-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUST",
        "first_name": "KEVIN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "SC",
            "license": "18311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA1122",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.