Jack E. Dobkin, D.O.
Individual provider Active NPI Cardiovascular Disease Physician · Laurens, SC
NPI 1194771469 · NPPES record last updated Jul 16, 2019
Key facts
- NPI
- 1194771469
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- 51708 (SC)
- Practice address
- 106 Parkview Dr
Laurens, SC 29360-2652 - Phone
- (864) 984-0571
- Fax
- (864) 984-3610
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 49
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prisma Health University Medical Group
Practice addresses (Care Compare)
106 Parkview Dr
Laurens, SC 29360-2652
Phone (864) 984-0571
Hospital & facility affiliations
- Prisma Health Laurens County Hospital
- Prisma Health Greenville Memorial Hospital
- Self Regional Healthcare
- Prisma Health Baptist Easley Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Pacemaker insertion or repair | 1-10 |
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 |
|---|---|---|---|---|
| I20180313002202 | SC | Practitioner - Cardiovascular Disease (Cardiology) |
2769436013 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8076 | CA | MD | Acupuncturist |
| 20A8076 | CA | MD | Cardiovascular Disease Physician |
| 51708 | SC | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prisma Health University Medical Group | Current |
Accepting new patients | |
| Prisma Health University Medical Group | Current |
Accepting new patients | |
| Caremore Medical Group | Cardiovascular Disease | Past | Accepting new patients |
Locations
210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123
1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306
2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761
106 Parkview Dr
Laurens, SC 29360
Phone (864) 454-0888
Interoperability endpoints
- jack.dobkin.p1@direct.caremorewest.nextgenshare.com
- jdobkin262584@direct.ghs.myhfn.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 20A8076 | CA | |
| Cardiovascular Disease Physician | 207RC0000X | 51708 | SC | Yes |
Addresses
Primary practice location
106 Parkview Dr
Laurens, SC 29360-2652
Mailing address
Dept la 23039
Pasadena, CA 91185-3039
Phone (562) 282-4038
Other practice location 1
9040 Telegraph Rd
Downey, CA 90240-2393
Phone (562) 861-0954
Other practice location 2
1690 Skylyn Dr Ste 350
Spartanburg, SC 29307-1039
Phone (864) 253-8110
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX80760 | Medicaid | CA | |
| 044862 | Other | HEALHT NET ID # | |
| 020A80760 | Other | BLUE SHIELD ID # | |
| 60066531 | Other | RAILROAD | |
| 60066532 | Other | RAILROAD | |
| 517088 | Medicaid | SC |
NPI Registry JSON
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563235200000",
"number": "1194771469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT LA 23039",
"city": "PASADENA",
"state": "CA",
"postal_code": "911853039",
"telephone_number": "562-282-4038",
"fax_number": "562-658-3397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 PARKVIEW DR",
"city": "LAURENS",
"state": "SC",
"postal_code": "293602652",
"telephone_number": "864-984-0571",
"fax_number": "864-984-3610"
}
],
"practiceLocations": [
{
"address_1": "9040 Telegraph Rd",
"address_purpose": "LOCATION",
"city": "Downey",
"state": "CA",
"postal_code": "902402393",
"country_code": "US",
"telephone_number": "562-861-0954",
"fax_number": "562-231-1904",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1690 Skylyn Dr Ste 350",
"address_purpose": "LOCATION",
"city": "Spartanburg",
"state": "SC",
"postal_code": "293071039",
"country_code": "US",
"telephone_number": "864-253-8110",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOBKIN",
"first_name": "JACK",
"middle_name": "E.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2019-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "20A8076",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "SC",
"license": "51708",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX80760",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALHT NET ID #",
"identifier": "044862",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD ID #",
"identifier": "020A80760",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "60066531",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "60066532",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "517088",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2019. 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.