NPIMap

Organization Active NPI

Prisma Health-Upstate

Doing business as Prisma Health Laurens Family Med-Main

  • Rural Health Clinic/Center
  • Laurens, SC
National Provider Identifier
1942755848
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PRISMA HEALTH-UPSTATE
Doing business as
Prisma Health Laurens Family Med-Main
Practice address
106 Parkview Dr
Laurens, SC 29360-2652
Phone
(864) 984-0571
NPI assigned
Aug 20, 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
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

106 Parkview Dr
Laurens, SC 29360-2652

Mailing address

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

Other names 1

  • Prisma Health Laurens Family Med-Main Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161118001638 SC Part A Provider - Rural Health Clinic 5698063162 Practice locations: Laurens, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942755848. Details of each certification follow.

Rural health clinic certification: CCN 423452

Legal name
PRISMA HEALTH-UPSTATE
Doing business as
PRISMA HEALTH LAURENS FAMILY MED-MAIN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 30, 2015
Last certification
Oct 7, 2021
Ownership / control type
2B
Most recent change of ownership
Oct 1, 2016 (2 total)
Organization structure
OtherNon-profit
Incorporated
Apr 1, 2019 in SC
Enrollment address
106 Parkview Dr
Laurens, SC 29360-2652
Related CCNs
420038

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

National Provider Directory

National Provider Directory
Tax ID family
PH Oconee Memorial Hospital121 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

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 DirectorDirector of Provider Enrollment Apr 5, 2020 100%
W-2 Managing EmployeeDirector, Provider Enrollment, Cvo Apr 5, 2020 100%
Polly H Miller Individual Corporate OfficerSVP Finance, Enterprise Contracting Mar 30, 2020 100%
W-2 Managing EmployeeSVP Finance, Enterprise Contracting Mar 30, 2020 100%
Operational/Managerial ControlSVP Finance, Enterprise Contracting Mar 30, 2020 100%
Prisma Health-Upstate Organization, Greenville, SC Created for acquisition 5% Or Greater Direct Ownership Interest Apr 1, 2019 100%
Operational/Managerial Control Apr 1, 2019 100%

All facility ownership & control disclosures 26

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Prisma Health Hillcrest HospitalSimpsonville, SC, CCN 420037 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Greer Memorial HospitalGreer, SC, CCN 420033 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Marshall I PickensGreenville, SC, CCN 42S078 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Roger C Peace RehabilitationGreenville, SC, CCN 42T078 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Pediatrics VerdaeGreenville, SC, CCN 420078 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Oconee Memorial HospitalSeneca, SC, CCN 420009 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Laurens County HospitalClinton, SC, CCN 420038 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 1, 2016
Oct 1, 2016
Prisma Health Patewood HospitalGreenville, SC, CCN 420102 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health North Greenville LtachTravelers Rest, SC, CCN 422008 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Baptist Easley Hospital O/P Therapy ServicesEasley, SC, CCN 420015 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2018
Oct 1, 2018
Prisma Health Home Health--UpstateGreenville, SC, CCN 427029 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Hospice of the FoothillsSeneca, SC, CCN 421508 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 1, 2019
Apr 1, 2019
PH Pediatrics-ClemsonClemson, SC, CCN 423455 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Laurens Family Med-Gray CTGray Court, SC, CCN 423454 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
PH Pediatrics-SenecaSeneca, SC, CCN 423456 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
Prisma Health Advanced Family MedicineClinton, SC, CCN 423458 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2016
Oct 1, 2016
PH Family Medicine-WalhallaWalhalla, SC, CCN 423475 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Seneca Medical AssociatesSeneca, SC, CCN 423474 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Mountain Lakes Family MedicineSeneca, SC, CCN 423476 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Family & Internal Medicine-SenecaSeneca, SC, CCN 423477 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Pediatrics-PowdersvilleGreenville, SC, CCN 423491 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Blue Ridge Women's CenterSeneca, SC, CCN 423490 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Primary Care Fountain InnFountain Inn, SC, CCN 423494 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Premier Women's CareGreenville, SC, CCN 423498 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Primary Care North GreenvilleTravelers Rest, SC, CCN 423495 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019
PH Family Medicine-PowdersvilleGreenville, SC, CCN 428501 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019

Facilities with the same owner 26

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 26

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2016 Change of OwnershipThis provider was the buyer Greenville Health SystemCCN 423452, SC, NPI 1710379193

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1471651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1942755848",
    "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": "106 PARKVIEW DR",
            "city": "LAURENS",
            "state": "SC",
            "postal_code": "293602652",
            "telephone_number": "864-984-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH-UPSTATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-20",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prisma Health Laurens Family Med-Main",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurens, SC

Sources for this page

Verify at the official NPI Registry.