Jake P Bostrom, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

31615 Issued in SC

Practice address

1520 Boiling Springs Rd
Boiling Springs, SC 29316

Phone

(864) 583-6381

Fax

(864) 583-6390

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

University of Tennessee, HSC, College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Palmetto Eye and Laser Center LLCGroup PAC ID 1850317819, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jake.bostrom@palmettoeyeandlaser.direct.eyemdemr.com

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.

• Palmetto Eye & Laser Center, LLC

  • Ophthalmology Physician
  • Boiling Springs, SC
  • NPI 1457384729
  Medicare reassignment Care Compare group NPD
• Carolina Specialty Eye Surgery, LLC

  • Ophthalmologic Surgery Clinic/Center
  • Boiling Springs, SC
  • NPI 1447870688
  Medicare reassignment NPD

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1295886125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "479 HEYWOOD AVE",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071726",
            "telephone_number": "864-583-6381",
            "fax_number": "864-583-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 BOILING SPRINGS RD",
            "city": "BOILING SPRINGS",
            "state": "SC",
            "postal_code": "29316",
            "telephone_number": "864-583-6381",
            "fax_number": "864-583-6390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "479 HEYWOOD AVE",
            "address_purpose": "LOCATION",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071726",
            "country_code": "US",
            "telephone_number": "864-583-6381",
            "fax_number": "864-583-6390",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSTROM",
        "first_name": "JAKE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "SC",
            "license": "31615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AA3955-7292",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC LICENSE",
            "identifier": "31615",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1457384729",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "316152",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01501403",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloomcare Group LLC
• Blue Ridge Dental LLC
• Boiling Springs Dentistry, LLC
• Boiling Springs First Baptist Church Counseling Service
• Felisha Booker
• Debra L Bower, RPH
• Charles William Brian, RPH
• Denequal Anne Brown Smith, DNP
• Dustin Kevin Brown, PARAMEDIC
• Rebecca Joy Brown, PNP

• Ophthalmology Physician in Boiling Springs, SC
• Providers in Boiling Springs, SC by specialty
• Ophthalmology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.