NPIMap

Individual provider Active NPI

John Edgar Kleckley, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Columbia, SC
National Provider Identifier
1356544100
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
29749 Issued in SC
Practice address
3710 Landmark Dr Ste 408
Columbia, SC 29204-4034
Phone
(803) 799-1922
NPI assigned
Jun 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 29749 SC Primary

Addresses

Primary practice location

3710 Landmark Dr Ste 408
Columbia, SC 29204-4034

Mailing address

PO Box 530062
Atlanta, GA 30353-0062
Phone (436) 956-0718

Other identifiers 3

IdentifierTypeStateIssuer
297495MedicaidSC
P00467100OtherSCRAILROAD MEDICARE PIN
P00803393OtherSCRAILROAD MEDICARE ID-RSFPN

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
I20071001000637 SC Practitioner - Geriatric MedicinePractitioner - Internal Medicine 0840385290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
University of South Carolina School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palmetto Primary Care Physicians LLCGroup PAC ID 4880508068, 148 clinicians

Practice addresses (Care Compare)

1200 Two Island CT
Unit E
Mt Pleasant, SC 29466-7418
Phone (854) 444-7676

Hospital & facility affiliations

  • Lutheran Hospice Hospice, White Rock, SC, CCN 421529
  • Prisma Health Richland Hospital Hospital, Columbia, SC, CCN 420018
  • Prisma Health Baptist Hospital, Columbia, SC, CCN 420086
  • Franke Health Care Center Nursing home, Mount Pleasant, SC, CCN 425374

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29749SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Palmetto Primary Care Physicians, LLC CurrentSince Jun 6, 2022 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Jun 6, 2022 Accepting new patients
Palmetto Primary Care Physicians, LLC Past Accepting new patients
Carolina Geriatric Specialists, LLC PastSince Apr 12, 2011 Accepting new patients
Internal Medical Associates, PA Geriatric Medicine Past Accepting new patients

Locations

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

3710 Landmark Dr
Ste 408
Columbia, SC 29204
Phone (803) 219-4686

1200 Two Island Ct
Unit E
Mt Pleasant, SC 29466
Phone (843) 849-1300

2500 Elms Center Rd
North Charleston, SC 29406
Phone (763) 348-2075

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

416 Robertson Blvd
Ste B
Walterboro, SC 29488
Phone (843) 549-2411

Interoperability endpoints

  • Direct secure messaging: john.kleckley@ppcp1.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Franke Health Care CenterMt Pleasant, SC, CCN 425374 Skilled nursing facility Adp of the SNF Mar 27, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 11

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": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1356544100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530062",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303530062",
            "telephone_number": "436-956-0718",
            "fax_number": "843-569-5879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 LANDMARK DR STE 408",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292044034",
            "telephone_number": "803-799-1922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLECKLEY",
        "first_name": "JOHN",
        "middle_name": "EDGAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "SC",
            "license": "29749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297495",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "P00467100",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE ID-RSFPN",
            "identifier": "P00803393",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.