SOUTH CAROLINA PROVIDER SERVICES, LLC
NPI 1003413469
Nurse Practitioner - Adult Health in Clemson, SC
About South Carolina Provider Services, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTH CAROLINA PROVIDER SERVICES, LLC (NPI 1003413469) is a healthcare organization registered as an adult health in Clemson, South Carolina and active in the NPI registry since October 2020. The organization maintains 6 additional practice locations and lists Gwendell Mcdaniel Kelley, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 6
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
South Carolina Provider Services, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to South Carolina Provider Services, LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is South Carolina Provider Services, LLC's NPI number?
The NPI number for South Carolina Provider Services, LLC is 1003413469. It was assigned to this organization in the NPPES registry on October 7, 2020.
Where is South Carolina Provider Services, LLC located?
South Carolina Provider Services, LLC is located at 500 Downs Loop, Clemson, SC 29631. The listed phone number is (864) 650-7475.
What is South Carolina Provider Services, LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.
Is South Carolina Provider Services, LLC enrolled in Medicare?
Yes. South Carolina Provider Services, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through South Carolina Provider Services, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to South Carolina Provider Services, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for South Carolina Provider Services, LLC was last updated on April 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# South Carolina Provider Services, Llc · NPI 1003413469
Adult Health organization in Clemson, South Carolina. Organization record, active in the CMS NPPES registry since October 7, 2020.
## Identity
- **NPI:** 1003413469 (Entity type: Organization)
- **Enumerated:** October 7, 2020
- **Primary specialty:** Nurse Practitioner - Adult Health · taxonomy 363LA2200X
- **Organization subpart:** No
- **Authorized official:** Gwendell Kelley, OWNER
## Practice location
- **Address:** 500 DOWNS LOOP, Clemson, SC 29631-2035
- **Phone:** (864) 650-7475
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 16, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1003413469) · Data from the CMS NPPES public registry.