Upstate Gastroenterology, PA

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

UPSTATE GASTROENTEROLOGY, PA

Practice address

1922A McConnell Springs Rd
Anderson, SC 29621-2642

Phone

(864) 716-6050

Fax

(864) 716-6055

NPI assigned

May 12, 2006

Organization subpart

No

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

Authorized official

Name

David T WorthamNPI 1437101771

Title

MD

Phone

(864) 716-6050

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 2

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

• David T. Wortham, MD

  • Gastroenterology Physician
  • Anderson, SC
  • NPI 1437101771
  Medicare reassignment NPD Authorized official
• Amanda Brooke Couch, NP

  • Nurse Practitioner
  • Anderson, SC
  • NPI 1700042520
  Medicare reassignment NPD

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310601600000",
    "number": "1851342067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1922A MCCONNELL SPRINGS RD",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296212642",
            "telephone_number": "864-716-6050",
            "fax_number": "864-716-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1922A MCCONNELL SPRINGS RD",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296212642",
            "telephone_number": "864-716-6050",
            "fax_number": "864-716-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE GASTROENTEROLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2011-07-14",
        "status": "A",
        "authorized_official_last_name": "WORTHAM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "864-716-6050"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3878",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DB7162",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennie Tyner
• Shameika Leanore Underwood
• Unique Faith Home Care Services LLC
• Upstate Behavioral Health
• Upstate Family Medicine LLC
• Upstate Medical Staffing, Inc.
• Upstate Physical Therapy
• Upstate Psychiatric Consulting LLC
• Upstate Rehab Services
• Upstate Tarheels, Inc. (Home Instead Anderson)

• Gastroenterology Physician in Anderson, SC
• Providers in Anderson, SC by specialty
• Gastroenterology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; 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.