NPIMap

Individual provider Active NPI

Kevin Sponseller, MD

  • Family Medicine Physician
  • Hartsville, SC
National Provider Identifier
1851709554
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39188 Issued in SC
Practice address
701 Medical Park Dr Ste 207
Hartsville, SC 29550-4778
Phone
(433) 832-7648
Fax
(843) 383-5171
NPI assigned
Jul 25, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Emergency Response Attendant 146D00000X
Family Medicine Physician 207Q00000X 62618-20 WI
Student in an Organized Health Care Education/Training Program 390200000X 62618-20 WI
Family Medicine Physician 207Q00000X 39188 SC Primary

Addresses

Primary practice location

701 Medical Park Dr Ste 207
Hartsville, SC 29550-4778

Mailing address

701 Medical Park Dr Ste 207
Hartsville, SC 29550-4778
Phone (433) 832-7648

Other practice location 1

849 Kellogg Ave
Janesville, WI 53546-2808
Phone (608) 755-7960

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
I20160706001573 SC Practitioner - Family Practice 3476773508 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartsville Medical Group LLCGroup PAC ID 7012062714, 78 clinicians

Practice addresses (Care Compare)

701 Medical Park Dr
Suite 207
Hartsville, SC 29550-4778
Phone (843) 332-6645

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39188SCMDFamily Medicine Physician
62618-20WIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Hartsville Medical Group LLC Family Medicine CurrentSince Jul 1, 2016 Accepting new patients
Ies South Carolina LLC CurrentSince Mar 1, 2024 Accepting new patients
Hartsville, LLC Past Accepting new patients

Locations

700 Medical Park Dr
Hartsville, SC 29550
Phone (843) 383-3742

701 Medical Park Dr
Ste 207
Hartsville, SC 29550
Phone (843) 332-6645

1304 W Bobo Newsom Hwy
Hartsville, SC 29550
Phone (469) 340-1366

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8689/brand/1/csg/1/fhir/r4
  • Direct secure messaging: sponseller.kevin.1@8689.direct.athenahealth.com

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 and National Provider Directory roles.

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": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1851709554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MEDICAL PARK DR STE 207",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295504778",
            "telephone_number": "433-832-7648",
            "fax_number": "843-383-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MEDICAL PARK DR STE 207",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295504778",
            "telephone_number": "433-832-7648",
            "fax_number": "843-383-5171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "849 Kellogg Ave",
            "address_purpose": "LOCATION",
            "city": "Janesville",
            "state": "WI",
            "postal_code": "535462808",
            "country_code": "US",
            "telephone_number": "608-755-7960",
            "fax_number": "608-755-7873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPONSELLER",
        "first_name": "KEVIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-25",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "62618-20",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": "62618-20",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "39188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartsville, SC

Sources for this page

Verify at the official NPI Registry.