NPIMap

Individual provider Active NPI

Jackie P. Stafford, DNP

  • Adult Health Nurse Practitioner
  • Cheraw, SC
National Provider Identifier
1609150622
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
17625 Issued in SC
Practice address
710 Chesterfield Hwy
Cheraw, SC 29520-7001
Phone
(843) 537-2171
Fax
(843) 537-5926
NPI assigned
Oct 10, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 17625 SC Primary

Addresses

Primary practice location

710 Chesterfield Hwy
Cheraw, SC 29520-7001

Mailing address

PO Box 3239
Florence, SC 29502-3239
Phone (843) 777-7098

Other identifiers 1

IdentifierTypeStateIssuer
NP1947MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jackie.stafford@mpaii.eclinicaldirectplus.com 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
I20120104000007 SC Practitioner - Nurse Practitioner 6800062415 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Medical University of South Carolina College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLeod Physician Associates IIGroup PAC ID 8224031307, 541 clinicians

Practice addresses (Care Compare)

710 Chesterfield Hwy
Cheraw, SC 29520-7001
Phone (843) 537-0010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Caresouth Carolina, Inc. Current Accepting new patients
Caresouth Carolina, Inc. CurrentSince Dec 5, 2011 Accepting new patients
McLeod Physician Associates II CurrentSince Mar 13, 2017 Accepting new patients
McLeod Physician Associates II CurrentSince Mar 13, 2017 Accepting new patients
McLeod Physician Associates II Past Accepting new patients
Art of Daily Living, Inc Past Accepting new patients

Locations

545 Sumter Hwy
Bishopville, SC 29010
Phone (803) 484-5317

710 Chesterfield Hwy
Cheraw, SC 29520
Phone (843) 537-0001

800 E Cheves St
Ste 240
Florence, SC 29506
Phone (843) 777-7950

800 E Cheves St
Ste 480A
Florence, SC 29506
Phone (843) 777-7337

3080 Highway 15-401 E
Mc Coll, SC 29570
Phone (843) 523-5751

Interoperability endpoints

  • Direct secure messaging: jstafford19616@directmcleodehealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1318204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1609150622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3239",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295023239",
            "telephone_number": "843-777-7098",
            "fax_number": "843-777-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 CHESTERFIELD HWY",
            "city": "CHERAW",
            "state": "SC",
            "postal_code": "295207001",
            "telephone_number": "843-537-2171",
            "fax_number": "843-537-5926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "JACKIE",
        "middle_name": "P.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-10",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "17625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1947",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jackie.stafford@mpaii.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "ECW DA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EHR",
            "address_1": "710 Chesterfield Hwy",
            "city": "Cheraw",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295207001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cheraw, SC

Sources for this page

Verify at the official NPI Registry.