NPIMap

Individual provider Active NPI

Jeremy R. Crisp, MD

  • Family Medicine Physician
  • Columbia, SC
National Provider Identifier
1205035342
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
29768 Issued in SC
Practice address
76 Polo Rd
Columbia, SC 29223-2806
Phone
(803) 699-7255
Fax
(803) 699-0848
NPI assigned
Jul 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 29768 SC Primary
Family Medicine Physician 207Q00000X LL29768 SC

Addresses

Primary practice location

76 Polo Rd
Columbia, SC 29223-2806

Mailing address

PO Box 6069
West Columbia, SC 29171-6069

Other identifiers 2

IdentifierTypeStateIssuer
AA53772353OtherSCMEDICARE PTAN
297681MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jcrisp14408@direct.lexmed.com

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
I20100917000399 SC Practitioner - Family Practice 5092830737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lexington Health IncGroup PAC ID 2567872070, 905 clinicians

Practice addresses (Care Compare)

76 Polo Rd
Columbia, SC 29223-2806
Phone (803) 699-7255

Hospital & facility affiliations

  • Amedisys Home Health of Camden Home health agency, Camden, SC, CCN 427036
  • Pruitthealth Home Health-Columbia Home health agency, Columbia, SC, CCN 427130
  • Lexington Medical Center Hospital, West Columbia, SC, CCN 420073
  • Prisma Health Baptist Hospital, Columbia, SC, CCN 420086
  • Prisma Health Richland Hospital Hospital, Columbia, SC, CCN 420018

Merit-based Incentive Payment System (MIPS)

Final score
84.09 of 100Reported as group
Quality
68.87
Promoting interoperability
100
Improvement activities
40
Cost
78.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL29768SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lexington Health Inc Family Medicine CurrentSince Feb 1, 2021 Accepting new patients
Lexington County Health Services District Inc Current Accepting new patients
Lexington Health Inc Family Medicine Current Accepting new patients
Lexington Health Inc CurrentSince Feb 1, 2021 Accepting new patients
Fairfield Memorial Hospital Past Accepting new patients
Lexington County Health Services District, Inc. Past Accepting new patients

Locations

76 Polo Rd
Columbia, SC 29223
Phone (803) 699-7255

122 Powell Dr
Lexington, SC 29072
Phone (803) 957-8400

811 W Main St
Ste 101
Lexington, SC 29072
Phone (803) 936-7230

Interoperability endpoints

  • Direct secure messaging: jcrisp14408@direct.lexmed.com

Organizations & group practices 6

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1205035342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6069",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291716069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 POLO RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292232806",
            "telephone_number": "803-699-7255",
            "fax_number": "803-699-0848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISP",
        "first_name": "JEREMY",
        "middle_name": "R.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-17",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "29768",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LL29768",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AA53772353",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297681",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcrisp14408@direct.lexmed.com",
            "affiliation": "N",
            "address_1": "76 Polo Rd",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292232806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.