Individual provider Active NPI

Jackqueline Ballentine Sims, FNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Greenwood, SC
National Provider Identifier
1275866840
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
3980 Issued in SC
Practice address
1547 Parkway
Greenwood, SC 29646-4081
Phone
(864) 229-7120
NPI assigned
Sep 14, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F3980 SC
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 3980 SC Primary

Addresses

Primary practice location

1547 Parkway
Greenwood, SC 29646-4081

Mailing address

1547 Parkway
Greenwood, SC 29646-4081
Phone (864) 229-7120

Other identifiers 2

IdentifierTypeStateIssuer
421504MedicaidSC
3335OtherSCMEDICARE

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
I20241025002774 SC Practitioner - Nurse Practitioner 4981137163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Carolina Dept of Mental Health Accounting OfficeGroup PAC ID 9032021175, 226 clinicians

Practice addresses (Care Compare)

1547 Pkwy
Suite 200
Greenwood, SC 29646-4081
Phone (864) 223-8331

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F3980SCMDFamily Nurse Practitioner
3980SCMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Carolina Dept of Mental Health Accounting Office CurrentSince Sep 4, 2024 Accepting new patients
South Carolina Dept of Mental Health Accounting Office CurrentSince Sep 4, 2024 Accepting new patients
South Carolina Dept of Mental Health Accounting Office Current Accepting new patients
Premise Health of South Carolina Medical, P.C PastSince Apr 1, 2021 Accepting new patients
South Carolina Dept of Mental Health Accounting Office Past Accepting new patients

Locations

125 E Robinson St
Gaffney, SC 29340
Phone (864) 487-2710

1547 Parkway
Ste 200
Greenwood, SC 29646
Phone (864) 223-8331

1547 Parkway
Greenwood, SC 29646
Phone (864) 223-8331

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770681600000",
    "number": "1275866840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1547 PARKWAY",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296464081",
            "telephone_number": "864-229-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1547 PARKWAY",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296464081",
            "telephone_number": "864-229-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMS",
        "first_name": "JACKQUELINE",
        "middle_name": "BALLENTINE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "F3980",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "3980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "421504",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "3335",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.