NPIMap

Organization Active NPI

Upstate Wellness Center LLC

  • Psychiatry Physician
  • Anderson, SC
National Provider Identifier
1871362459
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
UPSTATE WELLNESS CENTER LLC
Practice address
102 Buford Ave Ste a
Anderson, SC 29621-3365
Phone
(864) 261-9506
NPI assigned
Dec 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Authorized official

Name
Heather Marshall Ford, DNP, APRNNPI 1174165054
Title
Co-Owner, Provider
Phone
(864) 940-0523

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

102 Buford Ave Ste a
Anderson, SC 29621-3365

Mailing address

102 Buford Ave Ste a
Anderson, SC 29621-3365
Phone (864) 261-9506

Other practice location 1

2076 Woodruff Rd
Greenville, SC 29607-5939
Phone (864) 261-9506

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.upstatewellnesscenter@gmail.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240409003803 SC Part B Supplier - Clinic/Group Practice 8527406545 Receives reassigned benefits from 14 practitioners
Practice locations: Anderson, SC; Greenville, SC

National Provider Directory

National Provider Directory

Locations

102 Buford Ave
Ste A
Anderson, SC 29621
Phone (864) 224-2325

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1703462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1871362459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 BUFORD AVE STE A",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296213365",
            "telephone_number": "864-261-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 BUFORD AVE STE A",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296213365",
            "telephone_number": "864-261-9506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2076 Woodruff Rd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296075939",
            "country_code": "US",
            "telephone_number": "864-261-9506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UPSTATE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-25",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "MARSHALL",
        "authorized_official_title_or_position": "CO-OWNER, PROVIDER",
        "authorized_official_telephone_number": "864-940-0523",
        "authorized_official_credential": "DNP, APRN"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.upstatewellnesscenter@gmail.com",
            "affiliation": "N",
            "address_1": "102 Buford Ave Ste A",
            "city": "Anderson",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296213365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Anderson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; 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.