NPIMap

Individual provider Active NPI

Connie J Blackstone, MD

  • Internal Medicine Physician
  • Simpsonville, SC
National Provider Identifier
1497766588
Registry record updated Feb 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
15537 Issued in SC
Practice address
404 SE Main Street
Suite 300
Simpsonville, SC 29681-0279
Phone
(864) 963-8002
Fax
(864) 963-2742
NPI assigned
Aug 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 15537 SC Primary

Addresses

Primary practice location

404 SE Main Street
Suite 300
Simpsonville, SC 29681-0279

Mailing address

PO Box 279
404 SE Main Street
Simpsonville, SC 29681-0279
Phone (864) 963-8002

Other identifiers 2

IdentifierTypeStateIssuer
155370MedicaidSC
576007863095OtherSCBCBS

Other names 1

  • Miss Connie L Jumper Other name

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
I20070917000436 SC Practitioner - Internal Medicine 2769576115 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical University of South Carolina College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Francis Physician Services IncGroup PAC ID 6608826821, 106 clinicians

Practice addresses (Care Compare)

3970 Grandview Dr
Suite 2200
Simpsonville, SC 29680-3163
Phone (864) 963-8002

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Francis Physician Services Inc Internal Medicine CurrentSince Sep 20, 2014 Accepting new patients
St Francis Physician Services Inc CurrentSince Sep 20, 2014 Accepting new patients
Stoneview Internal Medicine PA Internal Medicine Current Accepting new patients
Greenville Health System Past Accepting new patients
St Francis Physician Services Inc Internal Medicine Past Accepting new patients

Locations

1200 Brookfield Blvd
Ste 400B
Greenville, SC 29607
Phone (864) 605-3721

404 SE Main St
Simpsonville, SC 29681
Phone (864) 228-1168

3970 Grandview Dr
Ste 2200
Simpsonville, SC 29680
Phone (864) 963-8002

727 SE Main St
Ste 300
Simpsonville, SC 29681
Phone (864) 522-1170

404 SE Main St
Ste 300
Simpsonville, SC 29681
Phone (864) 963-8002

Organizations & group practices 5

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.

Hospital & facility affiliations 54

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

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424304000000",
    "number": "1497766588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "address_2": "404 SE MAIN STREET",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296810279",
            "telephone_number": "864-963-8002",
            "fax_number": "864-963-2742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 SE MAIN STREET",
            "address_2": "SUITE 300",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296810279",
            "telephone_number": "864-963-8002",
            "fax_number": "864-963-2742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSTONE",
        "first_name": "CONNIE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2015-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "15537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155370",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "576007863095",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONNIE",
            "last_name": "JUMPER",
            "middle_name": "L",
            "prefix": "MISS",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Simpsonville, SC

Sources for this page

Verify at the official NPI Registry.