Individual provider Active NPI

Jeniqua Jefferson Duncan, DO

  • Family Medicine Physician
  • Hartsville, SC
National Provider Identifier
1316130800
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1094 Issued in SC
Practice address
1268 S 4TH St
Hartsville, SC 29550-0703
Phone
(843) 332-3422
Fax
(843) 332-3985
NPI assigned
Aug 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1094 SC Primary

Addresses

Primary practice location

1268 S 4TH St
Hartsville, SC 29550-0703

Mailing address

PO Box 1090
Hartsville, SC 29551-1090
Phone (843) 857-0111

Other practice location 1

555 E Cheves St
Florence, SC 29506-2617
Phone (843) 777-2800

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071128000516 SC Practitioner - Family Practice 4284723289 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1094SCMDSports Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Caresouth Carolina, Inc. Current Accepting new patients
Caresouth Carolina, Inc CurrentSince Feb 26, 2018 Accepting new patients
Caresouth Carolina, Inc Past Accepting new patients
Caresouth Carolina, Inc Past Accepting new patients
Caresouth Carolina, Inc Past Accepting new patients

Locations

1268 S 4th St
Ste B
Hartsville, SC 29550

1268 S 4th St
Hartsville, SC 29550
Phone (843) 332-3422

3080 Highway 15-401 E
Mc Coll, SC 29570
Phone (843) 523-5751

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": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1316130800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511090",
            "telephone_number": "843-857-0111",
            "fax_number": "843-857-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1268 S 4TH ST",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295500703",
            "telephone_number": "843-332-3422",
            "fax_number": "843-332-3985"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 E Cheves St",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "SC",
            "postal_code": "295062617",
            "country_code": "US",
            "telephone_number": "843-777-2800",
            "fax_number": "843-777-2810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUNCAN",
        "first_name": "JENIQUA",
        "middle_name": "JEFFERSON",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-20",
        "last_updated": "2021-07-26",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "1094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartsville, SC

Sources for this page

Verify at the official NPI Registry.