Active NPI
Richard Bruce Bannon, MD
- Family Medicine Physician
- Pacolet, SC
National Provider Identifier
1912959362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 7239
- Practice address
- 391 Glenn Springs Rd
Pacolet, SC 29372-2417 - Phone
- (864) 474-3013
- Fax
- (864) 474-1501
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 7239 | SC | Primary |
Addresses
Primary practice location
391 Glenn Springs Rd
Pacolet, SC 29372-2417
Mailing address
391 Glenn Springs Rd
Pacolet, SC 29372-2417
Phone (864) 474-3013
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00386835 | Other | GA | MEDICARE RAILROAD PTAN# |
| 072398 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1912959362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "391 GLENN SPRINGS RD",
"city": "PACOLET",
"state": "SC",
"postal_code": "293722417",
"telephone_number": "864-474-3013",
"fax_number": "864-474-1501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "391 GLENN SPRINGS RD",
"city": "PACOLET",
"state": "SC",
"postal_code": "293722417",
"telephone_number": "864-474-3013",
"fax_number": "864-474-1501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANNON",
"first_name": "RICHARD",
"middle_name": "BRUCE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "7239",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD PTAN#",
"identifier": "P00386835",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "072398",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pacolet, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.