Petra K Warren, M.D.

Key facts

NPI

1861450397

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

22043 (SC)

Practice address

230 S Alabama Ave
Chesnee, SC 29323-1504

Phone

(864) 461-4951

Fax

(864) 461-4956

NPI assigned

May 3, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Spartanburg Hospital for Restorative Care Family Medicine Physician · Spartanburg, SC · NPI 1649293580
  NPD (past) FAMILY MEDICINE

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 15, 2017.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497484800000",
    "number": "1861450397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S ALABAMA AVE",
            "city": "CHESNEE",
            "state": "SC",
            "postal_code": "293231504",
            "telephone_number": "864-461-4951",
            "fax_number": "864-461-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "PETRA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2017-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "22043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T63044",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P010990007",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesnee, SC

• Spartanburg School District Two
• Spartanburg School District Two
• Maryanne M Stoeppler, DO
• Donna D Swofford, R.N.
• Megan Rowe Wall, CPHT
• Michael Blair West, PHARMD
• Amanda Johnson Whitaker
• Jennifer L Winstead, CPHT
• Donna Wright, SLP

All providers in Chesnee, SC · Family Medicine Physician in South Carolina