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 |
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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 |
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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 |
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Provider Enumeration Date | 12/07/2020 |
Last Update Date | 06/29/2023 |
Certification Date | 06/29/2023 |
Medicare PECOS PAC ID | 3375959075 |
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Medicare Enrollment ID | O20210303003162 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023614914 | NPI | - | NPPES |
Provider Name | Tad Venn |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891810479 PECOS PAC ID: 0244386415 Enrollment ID: I20090914000545 |
Provider Name | Roland Ivan Saavedra |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1427011089 PECOS PAC ID: 4183711880 Enrollment ID: I20100726000427 |
Provider Name | Tisha A Williams |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1619084308 PECOS PAC ID: 5193638955 Enrollment ID: I20110315000735 |
Provider Name | Steven Miszkiewicz |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1548257249 PECOS PAC ID: 1456343128 Enrollment ID: I20110927000516 |
Provider Name | Latanya K Wright |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538398664 PECOS PAC ID: 7012061633 Enrollment ID: I20140407001813 |
Provider Name | Lakeisha Shunte Henderson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346613213 PECOS PAC ID: 7113228180 Enrollment ID: I20151216000934 |
Provider Name | Cynthia C Morris |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366806069 PECOS PAC ID: 2264722941 Enrollment ID: I20160608002076 |
Provider Name | Robert Kirby |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1568675551 PECOS PAC ID: 1658667563 Enrollment ID: I20160901000088 |
Provider Name | Shaquan Martee Brown |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053868810 PECOS PAC ID: 4284906140 Enrollment ID: I20170828001972 |
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 |
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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 | Jamie C Goodman |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1013956663 PECOS PAC ID: 4183607724 Enrollment ID: I20191107001578 |
Provider Name | Jeremy Alex Fuller |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841821162 PECOS PAC ID: 4082041660 Enrollment ID: I20200220000004 |
Provider Name | Griffin Myers |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1871817643 PECOS PAC ID: 7719145127 Enrollment ID: I20210303003257 |
Provider Name | Dillon Miller |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1619199056 PECOS PAC ID: 9436247319 Enrollment ID: I20210318000089 |
Provider Name | Justin Hunt |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1326138074 PECOS PAC ID: 6901842228 Enrollment ID: I20210318000436 |
Provider Name | Rachel Sabb |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1629321096 PECOS PAC ID: 0547412371 Enrollment ID: I20210610000391 |
Provider Name | Lisa Marie Amodio |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1063415909 PECOS PAC ID: 0941271951 Enrollment ID: I20220203000811 |
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 | Marisa Rogers |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1336171628 PECOS PAC ID: 8022185610 Enrollment ID: I20220808002492 |
Provider Name | Adrenna R Jackson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912644246 PECOS PAC ID: 1951784164 Enrollment ID: I20220822001835 |
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 | 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 |
Provider Name | Fayona Curenton |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1336508878 PECOS PAC ID: 7113289588 Enrollment ID: I20240516000170 |
Provider Name | Michelle L Rogers |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457100869 PECOS PAC ID: 2961937321 Enrollment ID: I20241121002015 |
Provider Name | Angela Renee Berry |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1174983878 PECOS PAC ID: 0749586022 Enrollment ID: I20241126001103 |
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