NPIMap

Organization Active NPI

Prisma Health-Upstate

Doing business as Prisma Health Oconee Pain Management

  • Pain Clinic/Center
  • Seneca, SC
National Provider Identifier
1891237632
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
Legal business name
PRISMA HEALTH-UPSTATE
Doing business as
Prisma Health Oconee Pain Management
Practice address
102B Omni Dr
Seneca, SC 29672
Phone
(864) 885-7971
Fax
(864) 885-7860
NPI assigned
Nov 10, 2016
Last updated
Feb 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Authorized official

Name
Polly H. Miller
Title
VP Payor Strategies & Alignment
Phone
(864) 522-2286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Clinic/Center 261QP3300X NU Primary

Addresses

Primary practice location

102B Omni Dr
Seneca, SC 29672

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 455-7000

Other names 1

  • Prisma Health Oconee Pain Management Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161118000794 SC Part A Provider - Hospital 5698063162 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seneca, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891237632. Details of each certification follow.

Hospital certification: CCN 420009

Legal name
PRISMA HEALTH-UPSTATE
Doing business as
PRISMA HEALTH OCONEE MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 20, 2017
Beds
169
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 2016 (3 total)
Organization structure
OtherNon-profit
Incorporated
Apr 1, 2019 in SC
Enrollment address
298 Memorial Dr
Seneca, SC 29672-9443
Other Hospital Practice Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Prisma Health Oconee Memorial HospitalCCN 420009 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristi a Lawrence Individual Corporate DirectorDir-Enrollment & Cvo Apr 5, 2020 100%
W-2 Managing EmployeeDir-Enrollment & Cvo Apr 5, 2020 100%
Polly H Miller Individual Corporate OfficerSVP-Fin Enterprise Contracting Mar 30, 2020 100%
W-2 Managing EmployeeSVP-Fin Enterprise Contracting Mar 30, 2020 100%
Operational/Managerial ControlSVP-Fin Enterprise Contracting Mar 30, 2020 100%
Prisma Health-Upstate Organization, Greenville, SC Created for acquisition 5% Or Greater Direct Ownership Interest Oct 1, 2016 100%
Operational/Managerial Control Oct 1, 2016 100%

Practitioners & affiliated clinicians

Affiliated clinicians 690

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 690

NPI Registry JSON

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

{
    "created_epoch": "1478736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1891237632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-455-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102B OMNI DR",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "29672",
            "telephone_number": "864-885-7971",
            "fax_number": "864-885-7860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH-UPSTATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-10",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "VP PAYOR STRATEGIES & ALIGNMENT",
        "authorized_official_telephone_number": "864-522-2286"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prisma Health Oconee Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seneca, SC

Sources for this page

Verify at the official NPI Registry.