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PRISMA HEALTH PRIMARY CARE FOUNTAIN INN
NPI 1164102927
Clinic/Center - Multi-Specialty in Fountain Inn, SC

Active since July 18, 2023CLIA 42D2237543 · Waiver
200 N NELSON DR, FOUNTAIN INN, SC 29644(864) 522-6270(864) 522-6275 Get Directions Write a Review

NPPES record last updated: October 12, 2023. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Oct 12, 2023, Jul 18, 2023 (2 updates tracked since 2023).

About Prisma Health Primary Care Fountain Inn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRISMA HEALTH PRIMARY CARE FOUNTAIN INN (NPI 1164102927) is a healthcare organization registered as a multi-specialty in Fountain Inn, South Carolina and active in the NPI registry since July 2023. The organization holds a CLIA Waiver certificate valid through September 26, 2027 and lists Polly H Miller, Svp Finance, Enterprise Contracting, as its authorized official.

NPPES Registry Identity

NPI1164102927
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NamePRISMA HEALTH-UPSTATE
Location Address200 N NELSON DRFountain Inn, SC 29644-9021
Mailing Address300 E Mcbee Ave Fl 4Greenville, SC 29601-2842
Phone(864) 522-6270
Fax(864) 522-6275
Organization SubpartNo
Authorized OfficialPolly H MillerSvp Finance, Enterprise Contracting · (864) 522-2286
Enumeration DateJuly 18, 2023
Last NPPES UpdateOctober 12, 20232 updates tracked since enumeration
NPPES CertifiedOctober 12, 2023
✔ NPI 1164102927 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
200 N NELSON DR, Fountain Inn, SC 29644
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Other Names 1

Doing Business AsPrisma Health Primary Care Fountain Inn

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 42D2237543

Prisma Health Primary Care Fountain Inn · Fountain Inn, SC
Active · expires Sep 26, 2027
CLIA Number42D2237543
Laboratory TypeRural Health Clinic
Certificate Effective DateSeptember 27, 2025
Certificate Expiration DateSeptember 26, 2027
Laboratory DirectorJeremy M. Byrd
Laboratory Phone(864) 522-6270
Laboratory LocationPrisma Health Primary Care Fountain Inn200 N Nelson Drive, Fountain Inn, SC 29644
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBERT MICHAEL HELLAMS
Family Medicine
200 N NELSON DR
FOUNTAIN INN, SC 29644
Greenville County (864) 522-3270
KELLY JORDAN SPENCE MD
Internal Medicine
200 N NELSON DR
FOUNTAIN INN, SC 29644
Greenville County (864) 522-6270
AUDREY GOODJOIN NP
Nurse Practitioner (Family)
200 N NELSON DR
FOUNTAIN INN, SC 29644
Greenville County (864) 522-6270
NICOLE ELIZABETH WELBORN FNP
Nurse Practitioner (Family)
200 N NELSON DR
FOUNTAIN INN, SC 29644
Greenville County (864) 522-6270
DR. ROBERT MICHAEL PARRICK D.O.
Internal Medicine
200 N NELSON DR
FOUNTAIN INN, SC 29644
Greenville County (864) 522-6270
SHELBY ELISE SPICER MD
Internal Medicine
200 N NELSON DR
FOUNTAIN INN, SC 29644
Greenville County (864) 522-6270
CAROLINE PARKIN FAIRCLOTH MD
Family Medicine
200 N NELSON DR
FOUNTAIN INN, SC 29644
Greenville County (864) 522-6270
MELISSA DOUGE DO
Internal Medicine
200 N NELSON DR
FOUNTAIN INN, SC 29644
Greenville County (864) 522-6270

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 Prisma Health-Upstate's NPI number?

The NPI number for Prisma Health-Upstate is 1164102927. It was assigned to this organization in the NPPES registry on July 18, 2023. The provider is doing business as Prisma Health Primary Care Fountain Inn.

Where is Prisma Health-Upstate located?

Prisma Health-Upstate is located at 200 N Nelson Dr, Fountain Inn, SC 29644. The listed phone number is (864) 522-6270.

What is Prisma Health-Upstate's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Prisma Health-Upstate hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 42D2237543) is associated with this NPI, valid through September 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Prisma Health-Upstate was last updated on October 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.