NPIMap

Individual provider Active NPI

Jackson M Ewart, MD

  • Vascular Surgery Physician
  • Georgetown, SC
National Provider Identifier
1699955005
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
8834 Issued in SC
Practice address
903 N Fraser St # a
Georgetown, SC 29440-2879
Phone
(843) 527-1331
Fax
(843) 527-1332
NPI assigned
Nov 14, 2007
Last updated
Aug 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 8834 SC
Vascular Surgery Physician 2086S0129X 8834 SC Primary

Addresses

Primary practice location

903 N Fraser St # a
Georgetown, SC 29440-2879

Mailing address

PO Box 1519
Georgetown, SC 29442-1519
Phone (843) 527-1331

Other practice location 1

3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone (803) 395-2200

Other identifiers 2

IdentifierTypeStateIssuer
7399OtherSCMEDICARE GROUP PTAN
088345MedicaidSC

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
I20111220000601 SC Practitioner - Vascular SurgeryPractitioner - General Surgery 0345324554 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8834SCMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians Surgery Current Accepting new patients
Georgetown Memorial Hospital CurrentSince Feb 5, 2014 Accepting new patients
The Regional Medical Center of Orangeburg and Calhoun Counties Current Accepting new patients
The Regional Medical Center of Orangeburg and Calhoun Counties Current Accepting new patients
Georgetown Physician Associates, LLC Current Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties CurrentSince Feb 1, 2017 Accepting new patients
Waccamaw Community Hospital CurrentSince Jul 1, 2013 Accepting new patients
Georgetown Physician Associates, LLC CurrentSince Sep 15, 2022 Accepting new patients
Georgetown Physician Associates LLC Surgery CurrentSince Sep 15, 2022 Accepting new patients
Georgetown Memorial Hospital CurrentSince Feb 5, 2014 Accepting new patients
Musc Community Physicians CurrentSince Mar 1, 2023 Accepting new patients
The Regional Medical Center of Orangeburg and Calhoun Counties CurrentSince Feb 1, 2017 Accepting new patients
Musc Community Physicians CurrentSince Mar 1, 2023 Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

606 Black River Rd
Georgetown, SC 29440
Phone (843) 527-7000

2347 S Highway 17
Murrells Inlet, SC 29576
Phone (843) 357-2443

4367 Riverwood Dr
Unit 140
Murrells Inlet, SC 29576
Phone (843) 357-3162

4070 Highway 17
Murrells Inlt, SC 29576
Phone (843) 357-5100

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

12117 Ocean Hwy
Pawleys Island, SC 29585
Phone (843) 237-8231

Interoperability endpoints

  • Direct secure messaging: jewart440536@direct.musc.edu
  • FHIR API: https://fhir-myrecord.cerner.com/r4/0fba742b-eec1-4103-87e5-edbdf1fe1e30/

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1699955005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1519",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294421519",
            "telephone_number": "843-527-1331",
            "fax_number": "843-527-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 N FRASER ST # A",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402879",
            "telephone_number": "843-527-1331",
            "fax_number": "843-527-1332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 Saint Matthews Rd",
            "address_purpose": "LOCATION",
            "city": "Orangeburg",
            "state": "SC",
            "postal_code": "291181442",
            "country_code": "US",
            "telephone_number": "803-395-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EWART",
        "first_name": "JACKSON",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-14",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "8834",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "SC",
            "license": "8834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "7399",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088345",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, SC

Sources for this page

Verify at the official NPI Registry.