DR. BRYAN K ELLENBERG (NPI# 1922092345) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922092345 |
| Entity Type | Individual |
| Full Name | DR. BRYAN K ELLENBERG |
| Credential | MD |
| Practice Address |
1228 Highway 72 W Greenwood SC 29649-1816 |
| Mailing Address |
1228 Hwy 72 West Greenwood SC 29649-1816 |
| Practice Telephone | 8649430549 |
| Practice Fax Number | 8642272067 |
| Mailing Telephone | 8649430549 |
| Mailing Fax Number | 8642272067 |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2015-07-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 17276 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | L19479 | 05 |
| Street Address |
1228 HIGHWAY 72 W |
| City | GREENWOOD |
| State | SC |
| Zip Code | 29649-1816 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841284254 | Cara A Friez | Family Medicine | 1228 Highway 72 W, Greenwood, SC 29649-1816 | 2005-08-31 |
| 1376930875 | Self Medical Group | Family Medicine | 1228 Highway 72 W, Greenwood, SC 29649-1816 | 2015-04-22 |
| 1609017193 | Paula B Haynes | Nurse Practitioner | 1228 Highway 72 W, Greenwood, SC 29649-1816 | 2009-03-13 |
| 1366413833 | John Vincent Maylock | Family Medicine | 1228 Highway 72 W, Greenwood, SC 29649-1816 | 2006-01-31 |
| 1538153861 | John M Ergle | Family Medicine | 1228 Highway 72 W, Greenwood, SC 29649-1816 | 2005-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346895455 | Prathamkumar Rakeshkumar Patel | Pharmacist | 508 By-pass 72 Northwest, Greenwood, SC 29649 | 2019-08-06 |
| 1821650284 | Lindsay Kay Fuqua | Dentist | 1302 Sc-72 Business, Greenwood, SC 29649 | 2019-07-05 |
| 1457830291 | Stephanie Dixon | Speech-Language Pathologist | 1075 Bypass 25 Ne, Greenwood, SC 29649 | 2018-08-13 |
| 1891286613 | Tylan Creek Family Dentistry Greenwood | Clinic/Center | 3710 Highway 221- 72e, Greenwood, SC 29649 | 2018-05-29 |
| 1225549090 | Tekola Moore | Registered Nurse | 150 By-pass 225, Greenwood, SC 29649 | 2017-10-19 |
| 1629588520 | Adrienne Jackson | Prosthetist | 2005 Old Laurens Rd, Greenwood, SC 29649 | 2017-10-05 |
| 1982141115 | Debras Hair Studio LLC | Prosthetic/Orthotic Supplier | 1516 Bypass 72 Ne Ste D, Greenwood, SC 29649 | 2017-01-25 |
| 1225406960 | Jim Nasim | Dentist | 101 West Durst Avenue, Greenwood, SC 29649 | 2015-09-11 |
| 1174905806 | Social Change Initiative | Case Management | 1402 C Hwy 72 West, Greenwood, SC 29649 | 2015-06-18 |
| 1346661683 | Cambridge Dental of Greenwood, LLC | Clinic/Center | 1302 Sc Hwy 72 W Business, Greenwood, SC 29649 | 2014-01-03 |
| Find all providers in zip 29649 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245862473 | Kristina Mckissick | Family Medicine | 805 Montague Ave, Greenwood, SC 29649-1471 | 2020-02-05 |
| 1487212130 | Self Medical Group | Family Medicine | 105 Vinecrest Ct # 510, Greenwood, SC 29646-8031 | 2019-05-29 |
| 1750800264 | Self Medical Group | Family Medicine | 110 Highway 246 N, Greenwood, SC 29649-8748 | 2017-09-15 |
| 1689066060 | Richard Glen Huber | Family Medicine | 31 N Restin Rd, Greenwood, IN 46142-8583 | 2015-02-23 |
| 1679912406 | Michael J. Mooney | Family Medicine | 965 Emerson Pkwy Ste J, Greenwood, IN 46143 | 2013-06-14 |
| 1114362639 | Sarah Ann Beeson | Family Medicine | 1000 Us Highway 31 S, Greenwood, IN 46143-2407 | 2013-05-10 |
| 1013350198 | Elise Rose Laroche | Family Medicine | 747 E County Line Rd Ste D, Greenwood, IN 46143-1082 | 2013-04-09 |
| 1548506868 | Community Health Network Inc | Family Medicine | 615 W Smith Valley Rd, Greenwood, IN 46142-3048 | 2012-12-13 |
| 1801158456 | Frank William Fortuna | Family Medicine | 461 Camby Court, Greenwood, IN 46142 | 2012-06-11 |
| 1417252636 | Self Medical Group | Family Medicine | 138 Wells Avenue, Greenwood, SC 29646-3837 | 2011-01-19 |
| Find all providers in GREENWOOD | ||||
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| 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.