Jon Dubose, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

200101440 Issued in NC

Practice address

111 Hospital Dr
Tarboro, NC 27886-2011

Phone

(252) 641-7700

Fax

(252) 641-7313

NPI assigned

May 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC, AL, SC3 enrollments

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 3

Specialty

Hospitalist

Education

University of South Carolina School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ies South Carolina LLCGroup PAC ID 1355705070, 16 clinicians

Hartsville Medical Group LLCGroup PAC ID 7012062714, 78 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carolina Pines Regional Medical Center Hospital, Hartsville, SC, CCN 420010
• McLeod Regional Medical Center-Pee Dee Hospital, Florence, SC, CCN 420051
• Musc Health Florence Medical Center Hospital, Florence, SC, CCN 420091

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jdubose227245@direct.unc.nchie.net
• FHIR API: https://api.platform.athenahealth.com/8689/brand/1/csg/1/fhir/r4

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.

• Hartsville Medical Group LLC

  • Internal Medicine Physician
  • Hartsville, SC
  • NPI 1598995300

  Internal Medicine, SC

  Medicare reassignment Care Compare group NPD
• Ies South Carolina LLC

  • Emergency Medicine Physician
  • Hartsville, SC
  • NPI 1821779695

  SC

  Medicare reassignment Care Compare group NPD
• Caldwell Memorial Hospital, Inc

  • Cardiovascular Disease Physician
  • Lenoir, NC
  • NPI 1477839108

  Internal Medicine, NC

  Medicare reassignment NPD
• East Carolina Health - Heritage Inc

  • Rural Health Clinic/Center
  • Pinetops, NC
  • NPI 1821076589

  NC

  Medicare reassignment NPD
• Capstone Health Services Foundation PC

  • Family Medicine Physician
  • Tuscaloosa, AL
  • NPI 1740397751

  AL

  Medicare reassignment NPD
• Musc Community Physicians

  • Internal Medicine Physician
  • Bamberg, SC
  • NPI 1841878006

  Internal Medicine, SC

  Medicare reassignment NPD
• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217

  Internal Medicine, SC

  Medicare reassignment NPD
• Whatley Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Tuscaloosa, AL
  • NPI 1063422756

  AL

  Medicare reassignment NPD
• Caldwell Memorial Hospital Inc

  • Hospitalist Physician
  • Lenoir, NC
  • NPI 1487694352

  Internal Medicine

  NPD
• Caldwell Memorial Hospital Inc.

  • Diagnostic Radiology Physician
  • Lenoir, NC
  • NPI 1255221180
  NPD
• Vidant Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Greenville, NC
  • NPI 1477648731
  NPD
• Capstone Health Services Foundation PC

  • Neurology Physician
  • Tuscaloosa, AL
  • NPI 1255212353
  NPD

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

• Hartsville, LLC

  • General Acute Care Hospital
  • Hartsville, SC
  • NPI 1174500458

  Hospital

  Care Compare affiliation
• McLeod Regional Medical Center of the Pee Dee, Inc.

  • General Acute Care Hospital
  • Florence, SC
  • NPI 1699756221

  Hospital

  Care Compare affiliation
• Medical University Hospital Authority

  • General Acute Care Hospital
  • Florence, SC
  • NPI 1184197683

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665532800000",
    "number": "1114920162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HOSPITAL DR",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278862011",
            "telephone_number": "252-641-7700",
            "fax_number": "252-641-7313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HOSPITAL DR",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278862011",
            "telephone_number": "252-641-7700",
            "fax_number": "252-641-7313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Grove Rd Fl 5",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296054210",
            "country_code": "US",
            "telephone_number": "864-455-4411",
            "fax_number": "864-455-4480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUBOSE",
        "first_name": "JON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "200101440",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "SC",
            "license": "87299",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "200101440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891330U",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdubose227245@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "321 Mulberry St SW",
            "city": "Lenoir",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286455720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vernice Dingle
• Bonnie Dixon, CPHT
• Tyeasia K Dorsey, CSAC, LCAS
• Tiffany Dowell
• Quatavius Downing
• Keosha Duson
• East Carolina Health - Heritage Inc
• East Carolina Health - Heritage Inc
• East Carolina Health - Heritage Inc
• East Carolina Health - Heritage Inc

• All providers in Tarboro, NC
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.