NPIMap

Individual provider Active NPI

John B Eberly, M.D.

  • Family Medicine Physician
  • Taylors, SC
National Provider Identifier
1093719320
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14967 Issued in SC
Practice address
4501 Old Spartanburg Rd
Taylors, SC 29687-4105
Phone
(864) 268-1119
Fax
(864) 268-1714
NPI assigned
May 27, 2005
Last updated
Jun 24, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14967 SC Primary

Addresses

Primary practice location

4501 Old Spartanburg Rd
Taylors, SC 29687-4105

Mailing address

4501 Old Spartanburg Rd
Taylors, SC 29687-4105
Phone (864) 268-1119

Other identifiers 5

IdentifierTypeStateIssuer
0103038OtherSCCAROLINA CARE PLAN
1035477OtherSCUNITED HEALTH CARE
149672MedicaidSC
57-0947101OtherSCTAX ID
49218OtherSCMEDCOST

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
I20070327000413 SC Practitioner - Family Practice 0143324491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Carolina School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Francis Physician Services IncGroup PAC ID 6608826821, 106 clinicians

Practice addresses (Care Compare)

1200 Brookfield Blvd
Suite 400B
Greenville, SC 29607-6583
Phone (864) 605-3721

4501 Old Spartanburg Rd
Suite 14
Taylors, SC 29687-4105
Phone (864) 268-1119

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Francis Physician Services Inc Family Medicine CurrentSince Nov 1, 2007 Accepting new patients
St Francis Physician Services Inc Family Medicine CurrentSince Nov 1, 2007 Accepting new patients
St Francis Physician Services Inc Family Medicine Past Accepting new patients

Locations

1200 Brookfield Blvd
Ste 400B
Greenville, SC 29607
Phone (864) 605-3721

4501 Old Spartanburg Rd
Ste 14
Taylors, SC 29687
Phone (864) 268-1119

Interoperability endpoints

  • Direct secure messaging: jeberly1150855@direct.bsmhealth.org

Organizations & group practices 3

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435104000000",
    "number": "1093719320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 OLD SPARTANBURG RD",
            "city": "TAYLORS",
            "state": "SC",
            "postal_code": "296874105",
            "telephone_number": "864-268-1119",
            "fax_number": "864-268-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 OLD SPARTANBURG RD",
            "city": "TAYLORS",
            "state": "SC",
            "postal_code": "296874105",
            "telephone_number": "864-268-1119",
            "fax_number": "864-268-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERLY",
        "first_name": "JOHN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2015-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "14967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAROLINA CARE PLAN",
            "identifier": "0103038",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1035477",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149672",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "57-0947101",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "49218",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylors, SC

Sources for this page

Verify at the official NPI Registry.