Active NPI
Jared Jackson Ivey
- Student in an Organized Health Care Education/Training Program
- Dillon, SC
National Provider Identifier
1407731441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 607 E Jefferson St
Dillon, SC 29536-3019 - Phone
- (843) 506-9763
- NPI assigned
- Aug 8, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | SC | Primary |
Addresses
Primary practice location
607 E Jefferson St
Dillon, SC 29536-3019
Mailing address
607 E Jefferson St
Dillon, SC 29536-3019
Phone (843) 506-9763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754611200000",
"number": "1407731441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "607 E JEFFERSON ST",
"city": "DILLON",
"state": "SC",
"postal_code": "295363019",
"telephone_number": "843-506-9763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "607 E JEFFERSON ST",
"city": "DILLON",
"state": "SC",
"postal_code": "295363019",
"telephone_number": "843-506-9763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVEY",
"first_name": "JARED",
"middle_name": "JACKSON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-08",
"last_updated": "2025-08-08",
"certification_date": "2025-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "SC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dillon, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.