Individual provider Active NPI

Jackson Byess, DPT

  • Physical Therapist
  • Simpsonville, SC
National Provider Identifier
1427418813
Registry record updated Feb 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8062 Issued in SC
Practice address
1409 W Georgia Rd
Ste C
Simpsonville, SC 29680-6419
Phone
(630) 296-2223
NPI assigned
Feb 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 8062 SC Primary

Addresses

Primary practice location

1409 W Georgia Rd
Ste C
Simpsonville, SC 29680-6419

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160413001028 SC Practitioner - Physical Therapist in Private Practice 8628376316 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greenville Proaxis Therapy LLCGroup PAC ID 0244267771, 221 clinicians

Practice addresses (Care Compare)

103 N Main St
Suite 201
Greenville, SC 29601-2756
Phone (864) 528-5753

111 Doctors Dr
Greenville, SC 29605-5622
Phone (864) 797-7020

1305 S Suber Rd
Greer, SC 29650-0944
Phone (864) 989-4700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8062SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Greenville Proaxis Therapy LLC CurrentSince Feb 9, 2016 Accepting new patients
Greenville Proaxis Therapy, LLC Physical Therapist CurrentSince Feb 9, 2016 Accepting new patients
Prisma Health University Medical Group Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33205 Collection Ctr Dr
Chicago, IL 60693

103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753

1305 S Suber Rd
Greer, SC 29650
Phone (864) 989-4609

1409 W Georgia Rd
Ste C
Simpsonville, SC 29680
Phone (864) 454-5012

Organizations & group practices 3

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": "1456704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456704000000",
    "number": "1427418813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 W GEORGIA RD",
            "address_2": "STE C",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296806419",
            "telephone_number": "630-296-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BYESS",
        "first_name": "JACKSON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-29",
        "last_updated": "2016-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "8062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simpsonville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.