Individual provider Active NPI

Gliset Restrepo, PA-C

  • Medical Physician Assistant
  • Lecanto, FL
National Provider Identifier
1821534926
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
9110146 Issued in FL
Practice address
1990 N Prospect Ave
Lecanto, FL 34461-9792
Phone
(352) 527-6888
NPI assigned
Jan 12, 2017
Last updated
Oct 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5991 SC
Medical Physician Assistant 363AM0700X 9110146 FL Primary

Addresses

Primary practice location

1990 N Prospect Ave
Lecanto, FL 34461-9792

Mailing address

PO Box 2066
Lecanto, FL 34460-2066
Phone (352) 527-6888

Other practice location 1

11402 Anderson Rd
Greenville, SC 29611-7557
Phone (864) 631-2799

Other identifiers 1

IdentifierTypeStateIssuer
023243500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180202000463 FL Practitioner - Physician Assistant 7517227986 Reassigns benefits to 2 organizations
I20251010003495 SC Practitioner - Physician Assistant 7517227986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Urgent Care of South Carolina PCGroup PAC ID 1254703788, 158 clinicians

Practice addresses (Care Compare)

115 State Park Rd
Greenville, SC 29609-2914
Phone (864) 438-3500

122 S Main St
Mauldin, SC 29662-2554
Phone (864) 284-4420

1298 Woodruff Rd
FL 4
Greenville, SC 29607-5754
Phone (864) 236-4700

1305 S Suber Rd
Greer, SC 29650-0944
Phone (864) 989-4609

6043 Calhoun Memorial Hwy
Easley, SC 29640-3811
Phone (803) 794-6780

718 Fairview Rd
Simpsonville, SC 29680-7117
Phone (864) 794-6555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5991SCMDOccupational Therapist
9110146FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Urgent Care of South Carolina, PC CurrentSince Oct 16, 2025 Accepting new patients

Locations

1305 S Suber Rd
Greer, SC 29650
Phone (864) 989-4609

11402 Anderson Rd
Powdersville, SC 29611
Phone (864) 631-2799

Interoperability endpoints

  • Direct secure messaging: grestrepo887853@direct.ghs.myhfn.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1821534926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2066",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344602066",
            "telephone_number": "352-527-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 N PROSPECT AVE",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344619792",
            "telephone_number": "352-527-6888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11402 Anderson Rd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296117557",
            "country_code": "US",
            "telephone_number": "864-631-2799",
            "fax_number": "864-522-1215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RESTREPO",
        "first_name": "GLISET",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-12",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "5991",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9110146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023243500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lecanto, FL

Sources for this page

Verify at the official NPI Registry.