NPIMap

Individual provider Active NPI

Jeffrey Clark Gersbach, M.D.

  • Emergency Medicine Physician
  • Johns Island, SC
National Provider Identifier
1548274343
Registry record updated Feb 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0101042360 Issued in VA
Practice address
2645 Burden Creek Rd
Johns Island, SC 29455-4604
Phone
(843) 224-0880
Fax
(425) 944-8954
NPI assigned
Jul 28, 2006
Last updated
Feb 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X 021585 SC
Emergency Medicine Physician 207P00000X 14843 SC
Emergency Medicine Physician 207P00000X 0101042360 VA Primary

Addresses

Primary practice location

2645 Burden Creek Rd
Johns Island, SC 29455-4604

Mailing address

2645 Burden Creek Rd
Johns Island, SC 29455-4604
Phone (843) 559-1958

Other identifiers 3

IdentifierTypeStateIssuer
010653103003OtherSCBCBS
148432 GP4105MedicaidSC
010653103OtherSCPRIVATE INSURANCE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgersbach124114@soc.inova.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050809000051 SC Practitioner - Emergency Medicine 2567491780 Reassigns benefits to 1 organization
I20140624000527 VA Practitioner - Emergency Medicine 2567491780 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Virginia Commonwealth University, School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bath County Community HospitalGroup PAC ID 0840193819, 29 clinicians
Hampton Regional Medical CenterGroup PAC ID 0941107296, 12 clinicians

Practice addresses (Care Compare)

106 Park Dr
Hot Springs, VA 24445-2921
Phone (540) 839-7000

595 W Carolina Ave
Varnville, SC 29944-4735
Phone (803) 943-2771

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14843SCMDSocial Worker
021585SCMDSports Medicine (Neuromusculoskeletal Medicine) Physician
0101042360VAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shenandoah Memorial Hospital, Inc. CurrentSince Jul 13, 2019 Accepting new patients
Bath County Community Hospital CurrentSince Apr 1, 2023 Accepting new patients
Hampton Regional Medical Center CurrentSince Nov 4, 2024 Accepting new patients
Shenandoah Memorial Hospital Inc. CurrentSince Jul 13, 2019 Accepting new patients
Hampton Regional Medical Center CurrentSince Nov 4, 2024 Accepting new patients
Shenandoah Memorial Hospital, Inc. Current Accepting new patients
Hampton Regional Medical Center Past Accepting new patients
Health Physicians, PC Neuromusculoskeletal Medicine, Sports Medicine Past Accepting new patients
Nason Medical Center V, LLC Past Accepting new patients
Nason Medical Center IV, LLC Past Accepting new patients
Bath County Community Hospital Past Accepting new patients

Locations

595 W Carolina Ave
Varnville, SC 29944
Phone (803) 943-1221

220 Campus Blvd
Ste 100
Winchester, VA 22601

240 Shenandoah St
Woodstock, VA 22664
Phone (540) 459-2808

759 S Main St
Woodstock, VA 22664
Phone (540) 459-1100

Interoperability endpoints

  • Direct secure messaging: jgersbach124114@soc.inova.org

Organizations & group practices 11

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614384000000",
    "number": "1548274343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2645 BURDEN CREEK RD",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294554604",
            "telephone_number": "843-559-1958",
            "fax_number": "843-225-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 BURDEN CREEK RD",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294554604",
            "telephone_number": "843-224-0880",
            "fax_number": "425-944-8954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERSBACH",
        "first_name": "JEFFREY",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2021-02-27",
        "certification_date": "2021-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "SC",
            "license": "021585",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "14843",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101042360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "010653103003",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "148432 GP4105",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE INSURANCE",
            "identifier": "010653103",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgersbach124114@soc.inova.org",
            "affiliation": "N",
            "address_1": "759 S Main St",
            "city": "Woodstock",
            "state": "VA",
            "country_code": "US",
            "postal_code": "226641154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Johns Island, SC

Sources for this page

Verify at the official NPI Registry.