PRISMA HEALTH PRIMARY CARE FOUNTAIN INN
NPI 1164102927
Clinic/Center - Multi-Specialty in Fountain Inn, SC
NPI Status: Active since July 18, 2023
Contact Information
200 N NELSON DR
FOUNTAIN INN, SC
ZIP 29644
Phone: (864) 522-6270
Fax: (864) 522-6275
- Organization
- Clinic/Center
- Multi-Specialty
- CLIA Number: 42D2269533
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 09-27-2026
About PRISMA HEALTH PRIMARY CARE FOUNTAIN INN
This page provides the complete NPI Profile along with additional information for Prisma Health Primary Care Fountain Inn, a provider established in Fountain Inn, South Carolina operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1164102927 assigned on July 2023. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated 3 years ago. The provider's is doing business as Prisma Health Primary Care Fountain Inn. The authorized official of this NPI record is Polly H Miller (Svp Finance, Enterprise Contracting)
- NPI
- 1164102927
- Provider Legal Name
- PRISMA HEALTH-UPSTATE
- Other Organization Name
- PRISMA HEALTH PRIMARY CARE FOUNTAIN INN
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 200 N NELSON DR FOUNTAIN INN, SC 29644
- Location Phone
- (864) 522-6270
- Location Fax
- (864) 522-6275
- Mailing Address
- 300 E MCBEE AVE FL 4 GREENVILLE, SC 29601
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 07-18-2023
- Last Update Date
- 10-12-2023
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Multi-Specialty
- Taxonomy Code
- 261QM1300X
- Type
- Ambulatory Health Care Facilities
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 42D2269533
- Facility Type
- Physician Office
- Certificate Effective Date
- September 28, 2024
- Certificate Expiration Date
- September 27, 2026
- Laboratory Director
- DR. ANTHONY PETRUSO
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Prisma Health Primary Care Fountain Inn to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1164102927, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 7 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164102927, enumerated as an "organization" on July 18, 2023.
The provider is located at 200 N NELSON DR FOUNTAIN INN, SC 29644 and the phone number is (864) 522-6270.
Clinic/Center with taxonomy code 261QM1300X and a focus in Multi-Specialty.
