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VIDA GYNECOLOGY
NPI 1699252163
Obstetrics & Gynecology in Greenville, SC

Active since July 26, 2018
330C PELHAM RD STE A, GREENVILLE, SC 29615(864) 720-1299(864) 720-1300 Get Directions Write a Review

NPPES record last updated: May 24, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 24, 2023, Jul 26, 2018 (2 updates tracked since 2018).

About Vida Gynecology NPPES

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

VIDA GYNECOLOGY (NPI 1699252163) is a healthcare organization registered as an obstetrics & gynecology in Greenville, South Carolina and active in the NPI registry since July 2018. The organization lists Bryanna Wyatt, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1699252163
Entity TypeOrganization
Primary Taxonomy207V00000X
Legal Business NamePS121 MANAGEMENT PA
Location Address330C PELHAM RD STE AGreenville, SC 29615-3111
Mailing Address330c Pelham Rd Ste AGreenville, SC 29615-3111 · (864) 720-1299 · Fax (864) 720-1300
Phone(864) 720-1299
Fax(864) 720-1300
Organization SubpartNo
Authorized OfficialBryanna WyattOffice Manager · (864) 720-1299
Enumeration DateJuly 26, 2018
Last NPPES UpdateMay 24, 20232 updates tracked since enumeration
NPPES CertifiedMay 24, 2023
✔ NPI 1699252163 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
330C PELHAM RD STE A, Greenville, SC 29615
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Other Names 1

Doing Business AsVida Gynecology

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of North Carolina and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Vida Gynecology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Vida Gynecology, which bills Medicare for the services they deliver. Of these, 5 practice at this address. They are listed nearest first.

Clinicians, nearest first (5)

Denise Broderick, M.D.
Obstetrics/Gynecology
NPI 1942250980
330C PELHAM RD SUITE 101C
Greenville, SC 29615
(864) 720-1299
✔ PECOS✔ Accepts MedicareSame address
Tamela Gallman Keller, M.D.
Obstetrics/Gynecology
NPI 1932137163
330 PELHAM RD STE 101C
Greenville, SC 29615
(864) 720-1299
✔ PECOS✔ Accepts MedicareSame address
Elizabeth Haswell, MD
Obstetrics/Gynecology
NPI 1407040645
330C PELHAM RD SUITE 101C
Greenville, SC 29615
(864) 720-1299
✔ PECOS✔ Accepts MedicareSame address
Kimberly Holloway, M.D.
Obstetrics/Gynecology
NPI 1447209374
330 PELHAM RD STE 101C
Greenville, SC 29615
(864) 720-1299
✔ PECOS✔ Accepts MedicareSame address
Andrea Wininger, M.D.
Obstetrics/Gynecology
NPI 1720023146
330C PELHAM RD STE A
Greenville, SC 29615
(864) 720-1299
✔ PECOSSame address

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 Ps121 Management PA's NPI number?

The NPI number for Ps121 Management PA is 1699252163. It was assigned to this organization in the NPPES registry on July 26, 2018. The provider is doing business as Vida Gynecology.

Where is Ps121 Management PA located?

Ps121 Management PA is located at 330C Pelham Rd Ste A, Greenville, SC 29615. The listed phone number is (864) 720-1299.

What is Ps121 Management PA's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Ps121 Management PA enrolled in Medicare?

Yes. Ps121 Management PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Ps121 Management PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians, all in Obstetrics/Gynecology, reassign their Medicare billing to Ps121 Management PA. 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. Of these, 5 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Ps121 Management PA accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, BlueCross BlueShield of South Carolina and First Choice Next and 2 other insurers list Ps121 Management PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ps121 Management PA was last updated on May 24, 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.