| Primarymd | |
|
2498 N Pleasantburg Dr Greenville SC 29609-2730 | |
| (864) 305-5000 | |
| (864) 840-8207 |
| Full Name | Primarymd |
|---|---|
| Speciality | General Practice |
| Location | 2498 N Pleasantburg Dr, Greenville, South Carolina |
| Authorized Official Name and Position | Jason Howard Blasenak (MEMBER) |
| Authorized Official Contact | 8649916156 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primarymd 2498 N. Pleasantburg Dr. Suite B Greenville SC 29609 Ph: (864) 991-6156 | Primarymd 2498 N Pleasantburg Dr Greenville SC 29609-2730 Ph: (864) 305-5000 |
| NPI Number | 1619383791 |
|---|---|
| Provider Enumeration Date | 07/09/2014 |
| Last Update Date | 10/30/2015 |
| Medicare PECOS PAC ID | 7416179478 |
|---|---|
| Medicare Enrollment ID | O20141107000731 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619383791 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Lane Eric Fresh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1417927542 PECOS PAC ID: 7214832781 Enrollment ID: I20031208000012 |
| Provider Name | Kevin Mewborn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669435327 PECOS PAC ID: 6103895164 Enrollment ID: I20040928000225 |
| Provider Name | Bradley Duane Davis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144200189 PECOS PAC ID: 4183693930 Enrollment ID: I20040928001079 |
| Provider Name | Tricia May Villanueva Harris |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427086909 PECOS PAC ID: 7012912124 Enrollment ID: I20060925000141 |
| Provider Name | Jason H Blasenak |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598785834 PECOS PAC ID: 4082666177 Enrollment ID: I20061214000477 |
| Provider Name | Christian Stephe Montagano |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780685040 PECOS PAC ID: 0042282998 Enrollment ID: I20090211000761 |
| Provider Name | David Scott Brancati |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871582247 PECOS PAC ID: 2668449562 Enrollment ID: I20090309000657 |
| Provider Name | Robert Steven Westrol |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1497796916 PECOS PAC ID: 8820091457 Enrollment ID: I20101019000686 |
| Provider Name | Damien L Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043518087 PECOS PAC ID: 0840475711 Enrollment ID: I20110420000144 |
| Provider Name | Jack Eric Colker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902869993 PECOS PAC ID: 1254518012 Enrollment ID: I20110602000526 |
| Provider Name | Jose Luis Plaza |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922031319 PECOS PAC ID: 3971673914 Enrollment ID: I20120914000385 |
| Provider Name | Mark P Doran |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649211913 PECOS PAC ID: 2961412879 Enrollment ID: I20130627000091 |
| Provider Name | Lopa Sisodia Bhansaly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154642726 PECOS PAC ID: 2961640545 Enrollment ID: I20130919000349 |
| Provider Name | Jay F Blankenship |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356583611 PECOS PAC ID: 9032365051 Enrollment ID: I20130925000834 |
| Provider Name | Felicia Tapp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538514351 PECOS PAC ID: 2860784014 Enrollment ID: I20160707001981 |
| Provider Name | Patrick M Jackson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629414701 PECOS PAC ID: 4587957006 Enrollment ID: I20160721000631 |
| Provider Name | Devon E Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730534348 PECOS PAC ID: 3971896077 Enrollment ID: I20160727001525 |
| Provider Name | Amber D Graham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780032631 PECOS PAC ID: 9739476649 Enrollment ID: I20160921000021 |
| Provider Name | Christine W Bright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629526231 PECOS PAC ID: 7012296080 Enrollment ID: I20161115000810 |
| Provider Name | Amy Lin Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861930398 PECOS PAC ID: 8123304177 Enrollment ID: I20170406000498 |
| Provider Name | Nicole M Scaccia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215961131 PECOS PAC ID: 7911929773 Enrollment ID: I20170725001753 |
| Provider Name | John C Wang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558511519 PECOS PAC ID: 3870621972 Enrollment ID: I20180314001972 |
| Provider Name | Staci Marie Holles-sobota |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740471077 PECOS PAC ID: 6406941798 Enrollment ID: I20180618003435 |
| Provider Name | Julie Gibbons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811287279 PECOS PAC ID: 0941470520 Enrollment ID: I20190828002976 |
| Provider Name | Julie Chesson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326605411 PECOS PAC ID: 0840521597 Enrollment ID: I20191009003623 |
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