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Prisma Health-Upstate

Organization Active NPI General Acute Care Hospital · Boiling Springs, SC

NPI 1902352008 · NPPES record last updated Sep 11, 2024

Key facts

NPI
1902352008
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
License
HTL-0936 (SC)
Legal business name
PRISMA HEALTH-UPSTATE
Practice address
2400 Boiling Springs Rd
Boiling Springs, SC 29316-5304
Phone
(864) 699-5700
Fax
(864) 699-5701
NPI assigned
Aug 29, 2016
Organization subpart
No

Authorized official

Name
Polly H. Miller
Title
SVP Fin-Enterprise Payor Contractin
Phone
(864) 522-2286

Other NPIs on the same Medicare enrollment 52

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

View all 52

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

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

Practitioners 3

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

Affiliated clinicians 2,058

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

View all 2,058

Medicare Care Compare: Hospital

Listed as
Prisma Health Greenville Memorial Hospital CCN 420078
Overall star rating
★★★★☆ 4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
No

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in SC

Hospital certification: CCN 420078

Legal name
PRISMA HEALTH-UPSTATE
Doing business as
PRISMA HEALTH PEDIATRICS VERDAE
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Nov 6, 1972
Last certification
Jun 12, 2015
Beds
845
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 2016 (1 total)
Organization structure
Other · Non-profit
Incorporated
Apr 1, 2019 in SC
Enrollment address
701 Grove Rd
Greenville, SC 29605-4210
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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 Director
Director, Provider Enrollment & Cvo		 Apr 5, 2020 100%
W-2 Managing Employee
Director, Provider Enrollment & Cvo		 Apr 5, 2020 100%
Polly H Miller
Individual 		Corporate Officer
SVP Finance, Enterprise Contracting		 Mar 20, 2020 100%
W-2 Managing Employee
SVP Finance, Enterprise Contracting		 Mar 20, 2020 100%
Operational/Managerial Control
SVP Finance, Enterprise Contracting		 Mar 20, 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%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20161118000626 SC Part a Provider - Hospital 5698063162 38 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20161222000767 SC Part B Supplier - Clinic/Group Practice 5698063162 Receives reassigned benefits from 438 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, SC; Greer, SC; Seneca, SC; Simpsonville, SC; Spartanburg, SC; Travelers Rest, SC; Clinton, SC; Easley, SC

National Provider Directory

Tax ID family
Upstate Affiliate Org (121 organizations share this tax ID)

Locations

22725 Highway 76 E
Fl 3
Clinton, SC 29325

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

131 Lila Doyle Dr
Seneca, SC 29672
Phone (864) 886-1911

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HTL-0936 SC Yes

Addresses

Primary practice location

2400 Boiling Springs Rd
Boiling Springs, SC 29316-5304

Mailing address

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

Other names

  • Prisma Health Cancer Inst-Spartanburg Doing business as

Other providers in Boiling Springs, SC

All providers in Boiling Springs, SC · General Acute Care Hospital in South Carolina

Sources for this page

Verify at the official NPI Registry.