PRISMA HEALTH UNIVERSITY MEDICAL GROUP (NPI# 1053786483) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053786483 |
| Entity Type | Organization |
| Organization Name | PRISMA HEALTH UNIVERSITY MEDICAL GROUP |
| Other Organization Name | UNIVERSITY MEDICAL GROUP/MOBILE HEALTH CLINIC |
| Practice Address |
701 Grove Rd Greenville SC 29605-4210 |
| Mailing Address |
1 Independence Pt Ste 212 Greenville SC 29615-4536 |
| Practice Telephone | 8647977875 |
| Practice Fax Number | 8647977880 |
| Mailing Telephone | 8643854790 |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2020-05-15 |
| Authorized Official Name | KRISTI ANN LAWRENCE (DIRECTOR PROVIDER ENROLLMENT) |
| Authorized Official Telephone | 8643854790 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| University Medical Group/Mobile Health Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205306099 | Prisma Health University Medical Group | Family Medicine | 110 Osage Drive, Greenville, SC 29605 | 2018-12-05 |
| 1730786096 | Prisma Health University Medical Group | Radiology | 1519 Marion St, Columbia, SC 29201-2910 | 2020-10-08 |
| 1114542081 | Prisma Health University Medical Group | Health Educator | 712 Grove Rd, Greenville, SC 29605-4211 | 2020-06-16 |
| 1295218642 | Prisma Health University Medical Group | Internal Medicine | 106 John St, Easley, SC 29640-1415 | 2018-09-12 |
| 1619411899 | Prisma Health University Medical Group | Durable Medical Equipment & Medical Supplies | 109 Fleetwood Dr, Suite B, Easley, SC 29640-2019 | 2016-12-07 |
| 1225480486 | Prisma Health University Medical Group | Pediatrics | 208 Frontage Rd, Suite 1, Clemson, SC 29631-1691 | 2016-07-12 |
| 1265884852 | Prisma Health University Medical Group | Durable Medical Equipment & Medical Supplies | 333 S Pine St, Spartanburg, SC 29302-2622 | 2016-07-07 |
| 1558754978 | Prisma Health University Medical Group | Orthopaedic Surgery | 10630 Clemson Blvd, Suite 100, Seneca, SC 29678-4546 | 2015-03-10 |
| 1528465374 | Prisma Health University Medical Group | Anesthesiology | 67 Creekside Park Ct, Greenville, SC 29615-4810 | 2014-11-21 |
| 1396141875 | Prisma Health University Medical Group | Optometrist | 104 Simpson St, Greenville, SC 29605-4413 | 2014-11-12 |
| Street Address |
701 GROVE RD |
| City | GREENVILLE |
| State | SC |
| Zip Code | 29605-4210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922002807 | Patricia A Stawaisz | Nurse Anesthetist, Certified Registered | 701 Grove Rd, Greenville, SC 29605-5611 | 2005-06-09 |
| 1851992648 | Sarah Sosebee | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-11-06 |
| 1942801097 | Kristin Cherie Davis | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-11-05 |
| 1679174650 | Kristin Welborn | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-11-05 |
| 1407457666 | Carmen Michele Faulkner-fennell | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-11-04 |
| 1134720568 | Amanda Parker | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-11-03 |
| 1053911693 | Ryan Walter Ridgeway | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-10-30 |
| 1891395083 | Tyler Kraft | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-10-28 |
| 1912507062 | Courtney Danielle Reddig | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-10-28 |
| 1063012128 | Adrienne Eubanks Bundrick | Pharmacist | 701 Grove Rd, Greenville, SC 29605-4210 | 2020-10-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205306099 | Prisma Health University Medical Group | Family Medicine | 110 Osage Drive, Greenville, SC 29605 | 2018-12-05 |
| 1306325626 | Lauren Foster Fiscus | Occupational Therapist | 1900 Augusta Street, Suite 2500, Greenville, SC 29605 | 2018-08-08 |
| 1063914372 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 1720 Augusta St, Greenville, SC 29605 | 2018-03-02 |
| 1144748385 | Johanna Ruth Henry | Speech-Language Pathologist | 1900 Augusta St., Suite 2500, Greenville, SC 29605 | 2017-09-08 |
| 1477083483 | Alexis Dean Pedigo | Speech-Language Pathologist | 1900 Augusta St, Suite 2500, Greenville, SC 29605 | 2017-06-13 |
| 1134658420 | Trace Christopher Deighan | Obstetrics & Gynecology | 890 West Faris Road, Suite 470, Greenville, SC 29605 | 2017-06-08 |
| 1023569837 | Blessed With Goodness, LLC | In Home Supportive Care | 716 E. Fairfield Road, Unit 120 (mailbox # 14), Greenville, SC 29605 | 2016-10-17 |
| 1972050953 | Suha Umina | Pharmacist | 975 W. Faris Road, Greenville, SC 29605 | 2016-09-07 |
| 1124470976 | Meredith Laine Cavagrotti | Specialist/Technologist | 700 Grove Rd, Greenville, SC 29605 | 2016-07-05 |
| 1205286895 | Med-trans Corporation | Ambulance | 552 Perimeter Rd, Greenville, SC 29605 | 2016-06-15 |
| Find all providers in zip 29605 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609482280 | Deanna Mclamb | Nurse Practitioner | 3102 Bell Arthur Rd, Greenville, NC 27834-4758 | 2020-09-19 |
| 1801401252 | Jodi Lynn Tesch | Nurse Practitioner | N984 Glennview Dr, Greenville, WI 54942-8531 | 2020-09-12 |
| 1760091482 | Melinda Kathryn Galford | Nurse Practitioner | 320 Falls St Apt 303, Greenville, SC 29601-2830 | 2020-07-28 |
| 1801414750 | Christopher Mangus | Nurse Practitioner | 1806 E 1st St Apt R9, Greenville, NC 27858-2214 | 2020-07-08 |
| 1932751559 | Caroline Gray Riddick | Nurse Practitioner | 527 Mills Ave # 201a, Greenville, SC 29605-5602 | 2019-07-13 |
| 1437621323 | Queeneice Boyette Ganison | Nurse Practitioner | 205 S Delta St, Greenville, MS 38703-4420 | 2018-12-18 |
| 1881169662 | Gerald Braden Wiggs | Nurse Practitioner | 3023 Fernleaf Dr, Greenville, NC 27858-8192 | 2018-10-09 |
| 1073091286 | Natalie Isbell Ragsdale | Nurse Practitioner | 20 Mcgee St, Greenville, SC 29601-2210 | 2018-07-31 |
| 1760980908 | Angela Nicole Gary | Nurse Practitioner | 1003 Grove Rd Ste C2, Greenville, SC 29605-4623 | 2018-01-23 |
| 1023527934 | Jennifer Anne Hovis | Nurse Practitioner | Hcr 2 5355, Greenville, MO 63944 | 2017-09-22 |
| Find all providers in GREENVILLE | ||||
| City | GREENVILLE |
| Zip Code | 29605 |
Please comment or provide details below to improve the information on PRISMA HEALTH UNIVERSITY MEDICAL GROUP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.