Jaclyn Marie Gravis, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

20386 Issued in SC

Practice address

2 Medical Park Rd
Suite 501
Columbia, SC 29203-6808

Phone

(803) 434-3320

Fax

(803) 540-1011

NPI assigned

Aug 2, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Carolina School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prisma Health Richland Hospital Hospital, Columbia, SC, CCN 420018

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jgravis379889@direct.ghs.myhfn.org

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.

• Prisma Health Medical Group-Midlands

  • Multi-Specialty Clinic/Center
  • Columbia, SC
  • NPI 1275988321
  Medicare reassignment Care Compare group NPD
• Prisma Health Medical Group-Midlands

  • Durable Medical Equipment & Medical Supplies
  • Columbia, SC
  • NPI 1881469856
  NPD

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

• Prisma Health Midlands

  • Geriatric Medicine (Internal Medicine) Physician
  • Columbia, SC
  • NPI 1962471946

  Hospital

  Care Compare affiliation
• Prisma Health-Midlands

  • General Acute Care Hospital
  • Columbia, SC
  • NPI 1033889795
  Care Compare affiliation
• Prisma Health-Midlands

  • General Acute Care Hospital
  • Columbia, SC
  • NPI 1154197846
  Care Compare affiliation
• Prisma Health-Midlands

  • General Acute Care Hospital
  • Columbia, SC
  • NPI 1154373843
  Care Compare affiliation
• Prisma Health-Midlands

  • General Acute Care Hospital
  • Coulmbia, SC
  • NPI 1154432458
  Care Compare affiliation
• Prisma Health-Midlands

  • General Acute Care Hospital
  • Columbia, SC
  • NPI 1396524104
  Care Compare affiliation
• Prisma Health-Midlands

  • General Acute Care Hospital
  • Columbia, SC
  • NPI 1508554452
  Care Compare affiliation

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1427501873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PARK RD",
            "address_2": "SUITE 501",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036808",
            "telephone_number": "803-434-3320",
            "fax_number": "803-540-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVIS",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-02",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "20386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP4147",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tomeka Grate-Taylor
• Graves Family Pharmacy and Clinic
• Alena Mae Graves, DMD
• Bryan Graves
• Crystal Cierra Graves, PHARMD
• Justin Robert Gravis, CRNA
• Valencia Giselle Gray-Williams, PHARM.D.
• Allyson Gray
• Carlotta Juliana Gray, APRN
• Enoch Kazeem Gray, M.D.

• Family Nurse Practitioner in Columbia, SC
• Providers in Columbia, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.