NPIMap

Individual provider Active NPI

Victoria Shadiack

  • Family Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1902291008
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
83156 Issued in SC
Practice address
101 E Wood St
Spartanburg, SC 29303-3040
Phone
(864) 560-6193
Fax
(864) 560-1510
NPI assigned
Apr 6, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 83156 SC Primary

Addresses

Primary practice location

101 E Wood St
Spartanburg, SC 29303-3040

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other identifiers 2

IdentifierTypeStateIssuer
SCJ2243365OtherSCMEDICARE PIN
831569MedicaidSC

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
I20201211002384 SC Practitioner - Family Practice 4880006097 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rowan University School of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, 1,060 clinicians

Practice addresses (Care Compare)

101 E Wood St
Spartanburg, SC 29303-3040
Phone (864) 560-1576

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
83156SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regenesis Organization Community Health Center CurrentSince Aug 30, 2021 Accepting new patients
Regenesis Organization Community Health Center Family Medicine CurrentSince Aug 30, 2021 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Regenesis Organization Community Health Center CurrentSince Aug 30, 2021 Accepting new patients
Spartanburg Medical Center CurrentSince Dec 10, 2020 Accepting new patients
Regenesis Organization Community Health Center CurrentSince Aug 30, 2021 Accepting new patients
Regenesis Organization Community Health Center Current Accepting new patients
Regenesis Organization Community Health Center CurrentSince Aug 30, 2021 Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Dec 10, 2020 Accepting new patients
Spartanburg Medical Center Past Accepting new patients

Locations

1341 N Limestone St
Gaffney, SC 29340
Phone (864) 489-3300

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

301 Crescent Ave
Spartanburg, SC 29306
Phone (864) 582-2817

750 S Church St
Spartanburg, SC 29306
Phone (864) 582-2829

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

460 Langdon St
Spartanburg, SC 29302
Phone (864) 582-2817

115 Thomas St
#B
Union, SC 29379

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1902291008",
    "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": "101 E WOOD ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033040",
            "telephone_number": "864-560-6193",
            "fax_number": "864-560-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADIACK",
        "first_name": "VICTORIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-06",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "83156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCJ2243365",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "831569",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.