Jackson B Bruce, MD
Individual provider Active NPI Family Medicine Physician · Piedmont, SC
NPI 1063597243 · NPPES record last updated Sep 15, 2011
Key facts
- NPI
- 1063597243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 19008 (SC)
- Practice address
- 115 Beattie Park Rd
Piedmont, SC 29673 - Phone
- (864) 845-3331
- Fax
- (864) 845-3152
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 47
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Medical College of Georgia School of Medicine, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- New Horizon Family Health Services Inc
Piedmont Family Practice LLC
Athens Family Medicine LLC
Practice addresses (Care Compare)
111 A Berry Ave
Greer, SC 29651-1307
Phone (864) 801-2035
115 Beattie Park Rd
Piedmont, SC 29673-1410
Phone (864) 845-3331
130 Mallard St
Greenville, SC 29601-4046
Phone (864) 233-1534
975 W Faris Rd
Greenville, SC 29605-4241
Phone (864) 729-8330
Hospital & facility affiliations
- Interim Healthcare of the Upstate
- Prisma Health Greenville Memorial Hospital
- St Francis-Downtown
- Anmed Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050822001311 | SC | Practitioner - Family Practice | 3476584236 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Piedmont Family Practice LLC | Family Medicine | Current |
Accepting new patients |
| Athens Family Medicine LLC | Family Medicine | Current |
Accepting new patients |
| New Horizon Family Health Services, Inc. | Current |
Accepting new patients | |
| New Horizon Family Health Services Inc | Current |
Accepting new patients | |
| St Francis Physician Services Inc | Family Medicine | Past | Accepting new patients |
| St Francis Physician Services Inc | Family Medicine | Past | Accepting new patients |
Locations
1 Saint Francis Dr
Greenville, SC 29601
Phone (864) 225-1000
130 Mallard St
Greenville, SC 29601
Phone (864) 233-1534
115 Beattie Park Rd
Piedmont, SC 29673
Phone (864) 845-3331
Interoperability endpoints
- https://api.platform.athenahealth.com/17492/brand/1/csg/1/fhir/r4
- jackson.bruce.1@17492.direct.athenahealth.com
- jackson.bruce.1@10133.direct.athenahealth.com
- jackson.bruce.1@32578.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 19008 | SC | Yes |
Addresses
Primary practice location
115 Beattie Park Rd
Piedmont, SC 29673
Mailing address
115 Beattie Park Rd
Piedmont, SC 29673
Phone (864) 845-3331
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19008 | Medicaid | SC |
Other providers in Piedmont, SC
- Britton Bideau
- Takasha Blassingame
- Brian M Elias DPM PC
- Brian M Elias DPM PC
- Robert Stephen Briggs Jr.
- Diane Brussell
- Robert Bryant
- Jennifer Burger
- Care Central RX, LLC
- Carolina Diagnostic Services
All providers in Piedmont, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.