NPIMap

Individual provider Active NPI

George Mack Jacob, M.D.

  • Psychiatry Physician
  • Greenville, SC
National Provider Identifier
1457508384
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
32952 Issued in SC
Practice address
701 Grove Rd
Greenville, SC 29605-4210
Phone
(864) 455-7899
Fax
(864) 455-5474
NPI assigned
Aug 21, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 32952 SC Primary

Addresses

Primary practice location

701 Grove Rd
Greenville, SC 29605-4210

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

2700 E Phillips Rd
Greer, SC 29650-4815
Phone (864) 235-2335

Other identifiers 1

IdentifierTypeStateIssuer
329521MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gjacob178272@direct.ghs.myhfn.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101227000774 SC Practitioner - Psychiatry 4284822719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of South Carolina School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prisma Health University Medical GroupGroup PAC ID 8325950983, 2,467 clinicians

Practice addresses (Care Compare)

210 Freeman Farm Rd
Duncan, SC 29334-9398
Phone (864) 968-5123

298 Memorial Dr
Seneca, SC 29672-9443
Phone (864) 455-2455

701 Grove Rd
Greenville, SC 29605-4210

Hospital & facility affiliations

  • Prisma Health Greenville Memorial Hospital Hospital, Greenville, SC, CCN 420078

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Oct 31, 2017 Accepting new patients
Prisma Health University Medical Group CurrentSince Oct 31, 2017 Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

11402 Anderson Rd
Ste A
Greenville, SC 29611
Phone (864) 631-2799

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

1115 Wren School Rd
Piedmont, SC 29673
Phone (864) 859-0740

Organizations & group practices 2

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.

Hospital & facility affiliations 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1457508384",
    "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": "701 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054210",
            "telephone_number": "864-455-7899",
            "fax_number": "864-455-5474"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 E Phillips Rd",
            "address_purpose": "LOCATION",
            "city": "Greer",
            "state": "SC",
            "postal_code": "296504815",
            "country_code": "US",
            "telephone_number": "864-235-2335",
            "fax_number": "864-877-1260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "GEORGE",
        "middle_name": "MACK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-21",
        "last_updated": "2022-07-21",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "32952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "329521",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gjacob178272@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "gjacob178272@direct.ghs.myhfn.org",
            "address_1": "701 Grove Rd",
            "city": "Greenville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296054210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.