Jonathan William Ceral Brock, MD, PHD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD34729 Issued in SC

Practice address

2318A Sunset Blvd
West Columbia, SC 29169-4716

Phone

(803) 796-9200

Fax

(803) 462-0312

NPI assigned

Jun 18, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

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.

• Lexington Health Inc

  • General Acute Care Hospital
  • West Columbia, SC
  • NPI 1386241834
  NPD (past)
• South Carolina Pediatrics Alliance, LLC

  • Pediatric Adolescent Medicine Physician
  • Columbia, SC
  • NPI 1184016941
  NPD (past)

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1417210279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 CLEMSON RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292294341",
            "telephone_number": "803-788-6146",
            "fax_number": "803-462-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2318A SUNSET BLVD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694716",
            "telephone_number": "803-796-9200",
            "fax_number": "803-462-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "JONATHAN",
        "middle_name": "WILLIAM CERAL",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-18",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "MD34729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bright Side Counseling LLC
• Keith Eric Brightbill II, M.D.
• Kristina Allane Bristow, FNP-BC
• Ralph R Britain, CRNA
• Joveida Lakeish Britt
• Katherine Danielle Brodie, MD
• Courtney R. Brooks, MD.
• Jennifer Sha Brooks
• Kasey Brough
• Anna Elaine Browder, PHARMD

• Pediatrics Physician in West Columbia, SC
• Providers in West Columbia, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.