NPIMap

Organization Active NPI

Jervey Eye Group, PA

  • Ophthalmology Physician
  • Simpsonville, SC
National Provider Identifier
1447220710
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
JERVEY EYE GROUP, PA
Practice address
1 Colony Centre Way
Simpsonville, SC 29681-3286
Phone
(864) 458-3900
Fax
(864) 967-9118
NPI assigned
Jan 26, 2006
Last updated
Sep 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Authorized official

Name
Brian Wells Shelley, MDNPI 1346274453
Title
Authorized Official
Phone
(864) 458-3900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1 Colony Centre Way
Simpsonville, SC 29681-3286

Mailing address

601 Halton Rd
Greenville, SC 29607-3403
Phone (864) 458-7956

Other identifiers 3

IdentifierTypeStateIssuer
CN1548OtherSCMEDICARE RAILROAD
DE1061OtherSCMEDICAID DMERC NUMBER
GP1669MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000033 SC Part B Supplier - Clinic/Group Practice 2860397148 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
Practice locations: Easley, SC; Greenville, SC; Simpsonville, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1 Colony Centre Way
Simpsonville, SC 29681
Phone (864) 458-3900

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1447220710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 HALTON RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296073403",
            "telephone_number": "864-458-7956",
            "fax_number": "864-458-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COLONY CENTRE WAY",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296813286",
            "telephone_number": "864-458-3900",
            "fax_number": "864-967-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERVEY EYE GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-26",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "SHELLEY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "WELLS",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "864-458-3900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CN1548",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DMERC NUMBER",
            "identifier": "DE1061",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1669",
            "state": "SC"
        }
    ],
    "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 Sep 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.