| Oak Street Health Physicians Group Of South Carolina, Llc | |
|
6119 White Horse Rd Ste 14 Greenville SC 29611-3838 | |
| (312) 733-9730 | |
| Not Available |
| Full Name | Oak Street Health Physicians Group Of South Carolina, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6119 White Horse Rd Ste 14, Greenville, South Carolina |
| Authorized Official Name and Position | Griffin Myers (CMO) |
| Authorized Official Contact | 3072642085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oak Street Health Physicians Group Of South Carolina, Llc 30 W Monroe St Ste 1200 Chicago IL 60603-2420 Ph: (312) 733-9730 | Oak Street Health Physicians Group Of South Carolina, Llc 6119 White Horse Rd Ste 14 Greenville SC 29611-3838 Ph: (312) 733-9730 |
| NPI Number | 1023614914 |
|---|---|
| Provider Enumeration Date | 12/07/2020 |
| Last Update Date | 06/29/2023 |
| Certification Date | 06/29/2023 |
| Medicare PECOS PAC ID | 3375959075 |
|---|---|
| Medicare Enrollment ID | O20210303003162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023614914 | NPI | - | NPPES |
| Provider Name | Sheila D Belton Gaymon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891879326 PECOS PAC ID: 8325025034 Enrollment ID: I20040701000201 |
| Provider Name | Lori P Cook |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255317723 PECOS PAC ID: 0941267165 Enrollment ID: I20041220000179 |
| Provider Name | Gail L Rearden |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568582906 PECOS PAC ID: 7618060005 Enrollment ID: I20070830000201 |
| Provider Name | Tonya Renee Washington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891780052 PECOS PAC ID: 8224118070 Enrollment ID: I20080107000014 |
| Provider Name | Tad Venn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891810479 PECOS PAC ID: 0244386415 Enrollment ID: I20090914000545 |
| Provider Name | Kimberly Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689812802 PECOS PAC ID: 6103952924 Enrollment ID: I20100331000962 |
| Provider Name | Tisha A Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619084308 PECOS PAC ID: 5193638955 Enrollment ID: I20110315000735 |
| Provider Name | Kesha Watkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083931372 PECOS PAC ID: 0840462743 Enrollment ID: I20111019000704 |
| Provider Name | Katherine D Lumpkin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346477254 PECOS PAC ID: 8022266998 Enrollment ID: I20120918000664 |
| Provider Name | Latanya K Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538398664 PECOS PAC ID: 7012061633 Enrollment ID: I20140407001813 |
| Provider Name | Mark A George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891176491 PECOS PAC ID: 8426368556 Enrollment ID: I20151102002199 |
| Provider Name | Lakeisha Shunte Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346613213 PECOS PAC ID: 7113228180 Enrollment ID: I20151216000934 |
| Provider Name | Cynthia C Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366806069 PECOS PAC ID: 2264722941 Enrollment ID: I20160608002076 |
| Provider Name | Robert Kirby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568675551 PECOS PAC ID: 1658667563 Enrollment ID: I20160901000088 |
| Provider Name | Juanita M Aviles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497273965 PECOS PAC ID: 7810254927 Enrollment ID: I20171128001764 |
| Provider Name | Amanda Elizabeth Smith Hamilton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447782859 PECOS PAC ID: 6103183959 Enrollment ID: I20171202000150 |
| Provider Name | Nicole Marie Segarra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811410475 PECOS PAC ID: 6800155755 Enrollment ID: I20180122002613 |
| Provider Name | Cynthia Bishop Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275046146 PECOS PAC ID: 9436419611 Enrollment ID: I20180208000307 |
| Provider Name | Isabel Dalence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427505114 PECOS PAC ID: 1850671926 Enrollment ID: I20180516000041 |
| Provider Name | Ashley V Watts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992287312 PECOS PAC ID: 6204174618 Enrollment ID: I20190211000844 |
| Provider Name | Hope H Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215499710 PECOS PAC ID: 4688900988 Enrollment ID: I20190724002646 |
| Provider Name | Jamie C Goodman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013956663 PECOS PAC ID: 4183607724 Enrollment ID: I20191107001578 |
| Provider Name | Griffin Myers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871817643 PECOS PAC ID: 7719145127 Enrollment ID: I20210303003257 |
| Provider Name | Dillon Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619199056 PECOS PAC ID: 9436247319 Enrollment ID: I20210318000089 |
| Provider Name | Justin Hunt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326138074 PECOS PAC ID: 6901842228 Enrollment ID: I20210318000436 |
| Provider Name | Rachel Sabb |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629321096 PECOS PAC ID: 0547412371 Enrollment ID: I20210610000391 |
| Provider Name | Rachel Hildebrand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528531258 PECOS PAC ID: 7416299748 Enrollment ID: I20220504001890 |
| Provider Name | Tuwanda Williamson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629018528 PECOS PAC ID: 6608817630 Enrollment ID: I20220511000447 |
| Provider Name | John Uche |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235103102 PECOS PAC ID: 6204860018 Enrollment ID: I20220610000235 |
| Provider Name | Marisa Rogers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336171628 PECOS PAC ID: 8022185610 Enrollment ID: I20220808002492 |
| Provider Name | Mira Desai |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538559190 PECOS PAC ID: 6800104787 Enrollment ID: I20220907000246 |
| Provider Name | Timanika Dansby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083016547 PECOS PAC ID: 5698061299 Enrollment ID: I20220909001049 |
| Provider Name | Thomas Nelson Kias |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609848373 PECOS PAC ID: 4284716507 Enrollment ID: I20221114000325 |
| Provider Name | Aiyanna Daishawn Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780302398 PECOS PAC ID: 6406228758 Enrollment ID: I20230214002125 |
| Provider Name | Phyllis Milburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164776563 PECOS PAC ID: 1850664897 Enrollment ID: I20231221000630 |
| Provider Name | Kathryn Denhof |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649934571 PECOS PAC ID: 1052757382 Enrollment ID: I20240308003337 |
| Provider Name | Levita Robinson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255606554 PECOS PAC ID: 3375852650 Enrollment ID: I20240425002442 |
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