Individual provider Active NPI

Robert Earl McDonald Jr., MD

  • Family Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1669452793
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12602 Issued in SC
Practice address
853 N Church St
Suite 510
Spartanburg, SC 29303-3098
Phone
(864) 560-1550
NPI assigned
Jan 17, 2006
Last updated
Feb 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17953 TN
Family Medicine Physician 207Q00000X 12602 SC Primary

Addresses

Primary practice location

853 N Church St
Suite 510
Spartanburg, SC 29303-3098

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other identifiers 2

IdentifierTypeStateIssuer
126027MedicaidSC
SC62355019OtherSCMEDICARE PIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050404000723 SC Practitioner - Family Practice 4688621444 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12602SCMDLicensed Practical Nurse
0000017953TNMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center Family Medicine Current Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Jun 12, 2015 Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Jan 1, 2020 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center CurrentSince Jun 12, 2015 Accepting new patients
Spartanburg Medical Center CurrentSince Jun 12, 2015 Accepting new patients
Interfaith Health Clinic, Inc Family Medicine Past Accepting new patients
Three Rivers Medical PastSince Apr 1, 2020 Accepting new patients
Abercrombie Radiological Consultants Inc Past Accepting new patients

Locations

2801 Woodruff Rd
Ste 101
Simpsonville, SC 29681
Phone (864) 849-9170

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554

1200 E Main St
Ste 12
Spartanburg, SC 29307
Phone (864) 560-9260

151 Peachwood Centre Dr
Spartanburg, SC 29301
Phone (864) 560-9627

2660 Reidville Rd
Unit 1
Spartanburg, SC 29301
Phone (864) 560-9696

853 N Church St
Ste 410A
Spartanburg, SC 29303
Phone (864) 560-6928

853 N Church St
Ste 510
Spartanburg, SC 29303
Phone (864) 560-1558

511 Cross Anchor Rd
Woodruff, SC 29388
Phone (864) 278-6031

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16930/brand/1/csg/1/fhir/r4

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1669452793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 N CHURCH ST",
            "address_2": "SUITE 510",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033098",
            "telephone_number": "864-560-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "ROBERT",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "17953",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "12602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126027",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SC62355019",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.