NPIMap

Individual provider Active NPI

Bryan K Ellenberg, MD

  • Family Medicine Physician
  • Greenwood, SC
National Provider Identifier
1922092345
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17276 Issued in SC
Practice address
1228 Highway 72 W
Greenwood, SC 29649-1816
Phone
(864) 943-0549
Fax
(864) 227-2067
NPI assigned
Aug 31, 2005
Last updated
Dec 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 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 17276 SC Primary

Addresses

Primary practice location

1228 Highway 72 W
Greenwood, SC 29649-1816

Mailing address

1228 Hwy 72 West
Greenwood, SC 29649-1816
Phone (864) 943-0549

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bellenberg127215@selfregional.direct-ci.net

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
I20100812000642 SC Practitioner - Family Practice 8123152121 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Carolina School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians
Self Regional HealthcareGroup PAC ID 4082527742, 159 clinicians

Practice addresses (Care Compare)

116 Venture CT
Greenwood, SC 29649-8558
Phone (864) 725-5594

1228 Hwy 72 W
Greenwood, SC 29649-1816
Phone (864) 943-0549

298 Commerce Dr
Newberry, SC 29108-2953
Phone (803) 321-3232

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Self Regional Healthcare CurrentSince Oct 2, 2025 Accepting new patients
Self Regional Healthcare Family Medicine CurrentSince Oct 2, 2025 Accepting new patients
Self Regional Healthcare Family Medicine Current Accepting new patients
Self Medical Group CurrentSince Jul 1, 2015 Accepting new patients
Self Medical Group CurrentSince Jul 1, 2015 Accepting new patients
Self Medical Group Current Accepting new patients
Self Regional Healthcare Past Accepting new patients
Self Regional Healthcare Family Medicine Past Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

75 Remittance Dr
Dept 6793
Chicago, IL 60675

75 Remittance Dr
Dept 6875
Chicago, IL 60675

1228 Highway 72 W
Greenwood, SC 29649
Phone (864) 943-0549

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

155 Academy Ave
Greenwood, SC 29646
Phone (864) 725-4865

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

103 Little Mountain Rd
Ninety Six, SC 29666
Phone (864) 223-5111

Interoperability endpoints

  • Direct secure messaging: bellenberg127215@selfregional.direct-ci.net

Organizations & group practices 9

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1922092345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 HWY 72 WEST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296491816",
            "telephone_number": "864-943-0549",
            "fax_number": "864-227-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 HIGHWAY 72 W",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296491816",
            "telephone_number": "864-943-0549",
            "fax_number": "864-227-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBERG",
        "first_name": "BRYAN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "17276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bellenberg127215@selfregional.direct-ci.net",
            "affiliation": "N",
            "address_1": "1228 Highway 72 W",
            "city": "Greenwood",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296491816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.