Individual provider Active NPI

John Taylor Autry

  • Emergency Medicine Physician
  • Chester, SC
National Provider Identifier
1447679170
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
83236 Issued in SC
Practice address
1 Medical Park Dr
Chester, SC 29706-9769
Phone
(803) 581-3151
NPI assigned
Apr 9, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036142175 IL
Emergency Medicine Physician 207P00000X 34.013414 OH
Emergency Medicine Physician 207P00000X 83236 SC Primary

Addresses

Primary practice location

1 Medical Park Dr
Chester, SC 29706-9769

Mailing address

PO Box 603898
Charlotte, NC 28260-3898
Phone (843) 792-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170719002284 IL Practitioner - Emergency Medicine 1557659968 Reassigns benefits to 3 organizations
I20200929001990 SC Practitioner - Emergency Medicine 1557659968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34.013414OHMDEmergency Medicine Physician
TP876KYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Aug 1, 2020 Accepting new patients
Carolina Family Care, Inc CurrentSince Sep 10, 2020 Accepting new patients
Valley Emergency Care Management, Inc. Emergency Medicine CurrentSince Jun 1, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Aug 1, 2020 Accepting new patients
Emergency Medicine Physicians of Cook County LLC Emergency Medicine CurrentSince Mar 15, 2021 Accepting new patients
Carolina Family Care, Inc CurrentSince Sep 10, 2020 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

1 Kish Hospital Dr
DeKalb, IL 60115
Phone (815) 754-1521

300 Randall Rd
Geneva, IL 60134
Phone (630) 208-4009

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

20201 Crawford Ave
Olympia Flds, IL 60461
Phone (708) 503-3857

1 Medical Park Dr
Chester, SC 29706
Phone (803) 581-3151

1341 Old Georgetown Rd
Ste C
Mt Pleasant, SC 29464
Phone (843) 884-2175

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1447679170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603898",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603898",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK DR",
            "city": "CHESTER",
            "state": "SC",
            "postal_code": "297069769",
            "telephone_number": "803-581-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AUTRY",
        "first_name": "JOHN",
        "middle_name": "TAYLOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-09",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036142175",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.013414",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "83236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chester, SC

Sources for this page

Verify at the official NPI Registry.