NPIMap

Individual provider Active NPI

Jessica Smith Willard, PA-C

  • Surgical Physician Assistant
  • Greenwood, SC
National Provider Identifier
1710058342
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1082 Issued in SC
Practice address
102 Gregor Mendel Cir
Greenwood, SC 29646-2315
Phone
(864) 229-2663
Fax
(864) 223-5694
NPI assigned
Nov 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 1082 SC Primary

Addresses

Primary practice location

102 Gregor Mendel Cir
Greenwood, SC 29646-2315

Mailing address

102 Gregor Mendel Cir
Greenwood, SC 29646-2315
Phone (864) 229-2663

Other identifiers 1

IdentifierTypeStateIssuer
0687PAMedicaidSC

Other names 1

  • Jessica Smith Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwillard127261@selfregional.direct-ci.net

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
I20051214000697 SC Practitioner - Physician Assistant 7517988801 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Medical Group 393 clinicians

Practice addresses (Care Compare)

102 Gregor Mendel Cir
Greenwood, SC 29646-2315
Phone (864) 229-2663

160 Academy Ave
Greenwood, SC 29646-3808
Phone (864) 223-8090

Hospital & facility affiliations

  • Home Health Services of Self Regional Healthcare Home health agency, Greenwood, SC, CCN 427018
  • Self Regional Healthcare Hospital, Greenwood, SC, CCN 420071
  • Abbeville Area Medical Center Hospital, Abbeville, SC, CCN 421301

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
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Jan 1, 2016 Accepting new patients
Self Medical Group CurrentSince Jan 1, 2016 Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients
Lakelands Orthopaedic Clinic Past Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

901 W Greenwood St
Ste 1
Abbeville, SC 29620
Phone (864) 229-2663

102 Gregor Mendel Cir
Greenwood, SC 29646
Phone (864) 229-2663

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Organizations & group practices 7

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 7

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1710058342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 GREGOR MENDEL CIR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462315",
            "telephone_number": "864-229-2663",
            "fax_number": "864-223-5694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 GREGOR MENDEL CIR",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462315",
            "telephone_number": "864-229-2663",
            "fax_number": "864-223-5694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "JESSICA",
        "middle_name": "SMITH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "1082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0687PA",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwillard127261@selfregional.direct-ci.net",
            "affiliation": "N",
            "address_1": "102 Gregor Mendel Cir",
            "city": "Greenwood",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296462315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "SMITH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.