NPIMap

Individual provider Active NPI

Jesse Clanton, M.D.

  • Surgery Physician
  • Columbia, SC
National Provider Identifier
1023246295
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
26438 Issued in WV
Practice address
2 Medical Park Rd Ste 300
Columbia, SC 29203-6839
Phone
(803) 545-5800
Fax
(803) 929-0492
NPI assigned
Jun 26, 2009
Last updated
Sep 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OH
Surgery Physician 208600000X 26438 WV Primary

Addresses

Primary practice location

2 Medical Park Rd Ste 300
Columbia, SC 29203-6839

Mailing address

3110 Maccorkle Ave SE
Charleston, WV 25304-1210
Phone (304) 347-1297

Other practice location 1

3100 MacCorkle Ave SE Ste 700
Charleston, WV 25304-1230
Phone (304) 556-3810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200115000004 SC Practitioner - General Surgery 6204065899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

2 Medical Park Rd
Suite 300
Columbia, SC 29203-6839
Phone (803) 545-5800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26438WVMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands Surgery CurrentSince Jan 15, 2020 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jan 15, 2020 Accepting new patients

Locations

166 Stoneridge Dr
Columbia, SC 29210
Phone (803) 296-5954

2 Medical Park Rd
Ste 300
Columbia, SC 29203
Phone (803) 434-8800

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

Interoperability endpoints

  • Direct secure messaging: jclanton377765@direct.ghs.myhfn.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1023246295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041210",
            "telephone_number": "304-347-1297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PARK RD STE 300",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036839",
            "telephone_number": "803-545-5800",
            "fax_number": "803-929-0492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 MacCorkle Ave SE Ste 700",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253041230",
            "country_code": "US",
            "telephone_number": "304-556-3810",
            "fax_number": "304-556-3820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLANTON",
        "first_name": "JESSE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-26",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WV",
            "license": "26438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.