Active NPI
Jacob Gibson
- Physician Assistant
- Columbia, SC
National Provider Identifier
1508701921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 6462
- Practice address
- 8 Richland Medical Park Dr Ste 300
Columbia, SC 29203-8008 - Phone
- (803) 256-6511
- Fax
- (803) 376-5885
- NPI assigned
- Apr 22, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 6462 | SC | Primary |
Addresses
Primary practice location
8 Richland Medical Park Dr Ste 300
Columbia, SC 29203-8008
Mailing address
300 E McBee Ave FL 4
Greenville, SC 29601-2842
Other practice location 1
8 Richland Medical Park Dr Ste 100
Columbia, SC 29203-8006
Phone (803) 434-3800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2026
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
300 E McBee Ave
Greenville, SC 29601-2842
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1776816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787184000000",
"number": "1508701921",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 RICHLAND MEDICAL PARK DR STE 300",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292038008",
"telephone_number": "803-256-6511",
"fax_number": "803-376-5885"
}
],
"practiceLocations": [
{
"address_1": "8 Richland Medical Park Dr Ste 100",
"address_purpose": "LOCATION",
"city": "Columbia",
"state": "SC",
"postal_code": "292038006",
"country_code": "US",
"telephone_number": "803-434-3800",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GIBSON",
"first_name": "JACOB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-04-22",
"last_updated": "2026-08-20",
"certification_date": "2026-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "6462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.