Active NPI
Vanessa Phung
- Pediatrics Physician
- Greenville, SC
National Provider Identifier
1871344887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- LL92464
- Practice address
- 5 W Main St
Greenville, SC 29611-4215 - Phone
- (866) 522-5220
- NPI assigned
- Mar 28, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | LL92464 | SC | Primary |
Addresses
Primary practice location
5 W Main St
Greenville, SC 29611-4215
Mailing address
5 W Main St
Greenville, SC 29611-4215
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241107000431 | SC | Order and Referring Only - Pediatric Medicine | 9436683901 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL92464 | SC | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722816000000",
"number": "1871344887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 W MAIN ST",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296114215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 W MAIN ST",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296114215",
"telephone_number": "866-522-5220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHUNG",
"first_name": "VANESSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-28",
"last_updated": "2024-08-05",
"certification_date": "2024-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "LL92464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.