NPIMap

Individual provider Active NPI

Jack Wade Brunson Jr., M.D.

  • Family Medicine Physician
  • Greer, SC
National Provider Identifier
1316918253
Registry record updated Dec 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10099 Issued in SC
Practice address
398 The Pkwy
Greer, SC 29650-4569
Phone
(864) 877-9577
Fax
(864) 877-9073
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2020

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 10099 SC Primary

Addresses

Primary practice location

398 The Pkwy
Greer, SC 29650-4569

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other identifiers 3

IdentifierTypeStateIssuer
SCI6605019OtherSCMEDICARE PIN
100991MedicaidSC
SCI6606067OtherSCMEDICARE PIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jbrunson217060@direct-srhs.et0939.epichosted.com Direct

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
I20100212000032 SC Practitioner - Family Practice 5395888481 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, shared by 17 NPIs, 1,060 clinicians

Practice addresses (Care Compare)

3611 Pelham Rd
Greenville, SC 29615-5002
Phone (864) 530-3500

398 The Pkwy
Greer, SC 29650-4569
Phone (864) 877-9577

Hospital & facility affiliations

  • Spartanburg Medical Center Hospital, Spartanburg, SC, CCN 420007
  • Pelham Medical Center Hospital, Greer, SC, CCN 420103
  • St Francis-Downtown Hospital, Greenville, SC, CCN 420023
  • Prisma Health Patewood Hospital Hospital, Greenville, SC, CCN 420102
  • Prisma Health Greer Memorial Hospital Hospital, Spartanburg, SC, CCN 420033

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10099SCMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center CurrentSince Aug 31, 2020 Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Aug 31, 2020 Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Aug 31, 2020 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
St Francis Physician Services Inc Family Medicine Past Accepting new patients

Locations

3611 Pelham Rd
Greenville, SC 29615
Phone (864) 530-3500

398 The Pkwy
Greer, SC 29650
Phone (864) 877-9577

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

2660 Reidville Rd
Unit 1
Spartanburg, SC 29301
Phone (864) 560-9696

Organizations & group practices 6

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 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1316918253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "398 THE PKWY",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296504569",
            "telephone_number": "864-877-9577",
            "fax_number": "864-877-9073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNSON",
        "first_name": "JACK",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "10099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCI6605019",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100991",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCI6606067",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbrunson217060@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jbrunson217060@direct-srhs.et0939.epichosted.com",
            "address_1": "398 The Pkwy",
            "city": "Greer",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296504569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greer, SC

Sources for this page

Verify at the official NPI Registry.