Individual provider Active NPI

Jon Kenneth Dumitru, MD

  • Emergency Medicine Physician
  • Greenville, SC
National Provider Identifier
1093919573
Registry record updated Jul 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
36835 Issued in SC
Practice address
701 Grove Rd
Greenville, SC 29605-4210
Phone
(864) 455-7000
NPI assigned
Jun 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2014

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 47147 TN
Emergency Medicine Physician 207P00000X ME 110005 FL
Emergency Medicine Physician 207P00000X 36835 SC Primary

Addresses

Primary practice location

701 Grove Rd
Greenville, SC 29605-4210

Mailing address

1 Independence PT
Suite 212
Greenville, SC 29615-4545
Phone (864) 797-6400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20110824000475 FL Practitioner - Emergency Medicine 8325218647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36835SCMDPharmacist
ME 110005FLMDEmergency Medicine Physician
47147TNMDEmergency Medicine Physician

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405036800000",
    "number": "1093919573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT",
            "address_2": "SUITE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154545",
            "telephone_number": "864-797-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054210",
            "telephone_number": "864-455-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUMITRU",
        "first_name": "JON",
        "middle_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-11",
        "last_updated": "2014-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "47147",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME 110005",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "36835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.