Individual provider Active NPI

Jack B Sizemore, PA

  • Physician Assistant
  • Greenville, SC
National Provider Identifier
1255644126
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1549 Issued in SC
Practice address
35 International Dr
Greenville, SC 29615-4816
Phone
(864) 234-7654
Fax
(864) 675-1657
NPI assigned
Jul 21, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1549 SC Primary

Addresses

Primary practice location

35 International Dr
Greenville, SC 29615-4816

Mailing address

35 International Dr
Greenville, SC 29615-4816
Phone (864) 234-7654

Other identifiers 1

IdentifierTypeStateIssuer
1036PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110202000806 SC Practitioner - Physician Assistant 4183804552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours Medical Group Greenville Specialty Care LLCGroup PAC ID 1850779976, 290 clinicians

Practice addresses (Care Compare)

1 Saint Francis Dr
Greenville, SC 29601-3955
Phone (513) 853-8520

1050 Grove Rd
Greenville, SC 29605-4649
Phone (864) 234-7654

125 Commonwealth Dr
Greenville, SC 29615-4812
Phone (864) 675-4000

317 Saint Francis Dr
Suite 220
Greenville, SC 29601-3976
Phone (864) 255-1901

35 International Dr
Greenville, SC 29615-4816
Phone (864) 513-1136

Hospital & facility affiliations

  • Interim Healthcare of the Upstate Home health agency, Greenville, SC, CCN 427015
  • St Francis-Downtown Hospital, Greenville, SC, CCN 420023

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 21, 2022 Accepting new patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 21, 2022 Accepting new patients
St Francis Physician Services Inc Past Accepting new patients

Locations

317 Saint Francis Dr
Ste 220
Greenville, SC 29601
Phone (864) 255-1901

1050 Grove Rd
Greenville, SC 29605
Phone (864) 242-5020

35 International Dr
Greenville, SC 29615
Phone (864) 242-5020

Interoperability endpoints

  • Direct secure messaging: jsizemore1155818@direct.bsmhealth.org

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 7

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": "1279670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466640000000",
    "number": "1255644126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 INTERNATIONAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154816",
            "telephone_number": "864-234-7654",
            "fax_number": "864-675-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 INTERNATIONAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154816",
            "telephone_number": "864-234-7654",
            "fax_number": "864-675-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIZEMORE",
        "first_name": "JACK",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-21",
        "last_updated": "2016-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1036PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.