NPIMap

Individual provider Active NPI

Jacob Goatley, MD

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Charleston, SC
National Provider Identifier
1235753518
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
License
57.249415 Issued in OH
Practice address
135 Cannon St Ste 405
Charleston, SC 29425-3800
Phone
(843) 792-2575
NPI assigned
Jun 3, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 57.249415 OH
Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X 57.249415 OH Primary

Addresses

Primary practice location

135 Cannon St Ste 405
Charleston, SC 29425-3800

Mailing address

169 Ashley Ave RM 202
Charleston, SC 29425-8905
Phone (843) 792-2575

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
I20251110000418 SC Practitioner - Physical Medicine and RehabilitationPractitioner - Sports Medicine 1759760754 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Sports Medicine
Education
University of Toledo College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57.249415OHMDSports Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol CurrentSince Sep 9, 2025 Accepting new patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients
University of Toledo Physicians LLC PastSince Jun 1, 2020 Accepting new patients

Locations

2060 Sam Rittenberg Blvd
Charleston, SC 29407
Phone (843) 876-0111

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

169 Ashley Ave
Rm 202
Charleston, SC 29425
Phone (843) 792-0192

135 Cannon St
Ste 405
Charleston, SC 29425
Phone (843) 792-2575

1122 Chuck Dawley Blvd
Bldg B
Mt Pleasant, SC 29464
Phone (843) 792-5434

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1235753518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE RM 202",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-792-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 CANNON ST STE 405",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294253800",
            "telephone_number": "843-792-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOATLEY",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-03",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "57.249415",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "OH",
            "license": "57.249415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.