Individual provider Active NPI

Jacob A McKenna

  • Emergency Medicine Physician
  • Columbia, SC
National Provider Identifier
1063107167
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
89728 Issued in SC
Practice address
14 Richland Medical Park Dr Ste 350
Columbia, SC 29203-6896
Phone
(803) 434-3790
NPI assigned
Apr 6, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 89728 SC Primary

Addresses

Primary practice location

14 Richland Medical Park Dr Ste 350
Columbia, SC 29203-6896

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 695-6697

Other practice location 1

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4780

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250807003135 SC Practitioner - Emergency Medicine 0042671778 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Alabama College of Osteopathic Medicine, 2023
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)

14 Richland Medical Park Dr
Suite 350
Columbia, SC 29203-6896
Phone (803) 434-1319

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
89728SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Aug 1, 2025 Accepting new patients
Self Medical Group Current Accepting new patients
Self Medical Group Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: jmckenna650445@direct.ghs.myhfn.org

Organizations & group practices 5

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

Hospital & facility affiliations 1

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": "1680739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760313600000",
    "number": "1063107167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-695-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 RICHLAND MEDICAL PARK DR STE 350",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036896",
            "telephone_number": "803-434-3790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Spring St",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296463860",
            "country_code": "US",
            "telephone_number": "864-725-4780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "JACOB",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-06",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "89728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.