NPIMap

Individual provider Active NPI

Jessica McKenzie Grimsley, FNP

  • Family Nurse Practitioner
  • Lake City, SC
National Provider Identifier
1255799631
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19962 Issued in SC
Practice address
276 N Ron McNair Blvd
Lake City, SC 29560-2462
Phone
(843) 394-5471
NPI assigned
Feb 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 19962 SC Primary

Addresses

Primary practice location

276 N Ron McNair Blvd
Lake City, SC 29560-2462

Mailing address

PO Box 23467
New York, NY 10087-3467
Phone (843) 792-6200

Other practice location 1

1303 38th Ave N
Myrtle Beach, SC 29577-1315
Phone (843) 448-4437

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Health Information Exchange (HIE)

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
I20160601000900 SC Practitioner - Nurse Practitioner 5799075958 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical University Hospital AuthorityGroup PAC ID 1557268950, 218 clinicians
Lower Florence County HosptialGroup PAC ID 6608802152, 4 clinicians

Practice addresses (Care Compare)

148 Sauls St
Lake City, SC 29560-2677
Phone (843) 374-3621

258 N Ron McNair Blvd
Lake City, SC 29560-2462

276 N Ron McNair Blvd
Lake City, SC 29560-2462
Phone (843) 394-5471

500 Thurgood Marshall Hwy
Suite F
Kingstree, SC 29556-4143
Phone (843) 355-1772

Hospital & facility affiliations

  • Musc Health Florence Medical Center Hospital, Florence, SC, CCN 420091
  • CCN 420117 Hospital, CCN 420117
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
19962SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical University Hospital Authority CurrentSince Oct 1, 2022 Accepting new patients
Medical University Hospital Authority CurrentSince Oct 1, 2022 Accepting new patients
Maqsood Medical Services LLC CurrentSince Mar 29, 2016 Accepting new patients
Medical University Hospital Authority Current Accepting new patients

Locations

121 E Cedar St
Florence, SC 29506
Phone (843) 661-3499

500 Thurgood Marshall Hwy
Ste F
Kingstree, SC 29556
Phone (843) 355-1774

276 N Ron McNair Blvd
Lake City, SC 29560
Phone (843) 394-1051

511 S Main St
Mullins, SC 29574
Phone (843) 464-8244

Interoperability endpoints

  • Direct secure messaging: jgrimsley75690@direct.musc.edu

Organizations & group practices 4

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 8

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": "1454284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1255799631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23467",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873467",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 N RON MCNAIR BLVD",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602462",
            "telephone_number": "843-394-5471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1303 38th Ave N",
            "address_purpose": "LOCATION",
            "city": "Myrtle Beach",
            "state": "SC",
            "postal_code": "295771315",
            "country_code": "US",
            "telephone_number": "843-448-4437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIMSLEY",
        "first_name": "JESSICA",
        "middle_name": "MCKENZIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-01",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "276 N Ron McNair Blvd",
            "city": "Lake City",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295602462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

Verify at the official NPI Registry.