Nicholas Xavier Jebaily, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2013-01215 Issued in NC

Practice address

4444 N 32ND St Ste 175
Phoenix, AZ 85018-3999

Phone

(602) 952-0002

Fax

(602) 224-9119

NPI assigned

May 27, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Specialty

Cardiovascular Disease (Cardiology)

Education

Medical University of South Carolina College of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McLeod Regional Medical Center of the Pee Dee IncGroup PAC ID 7416851852, 401 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLeod Regional Medical Center-Pee Dee Hospital, Florence, SC, CCN 420051
• McLeod Loris Hospital Hospital, Loris, SC, CCN 420105
• Grand Strand Regional Medical Center Hospital, Myrtle Beach, SC, CCN 420085

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: njebaily22240@directmcleodehealth.org

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.

• McLeod Regional Medical Center of the Pee Dee, Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Florence, SC
  • NPI 1154371433

  Family Medicine

  Medicare reassignment Care Compare group NPD
• McLeod Loris Seacoast Hospital

  • Certified Registered Nurse Anesthetist
  • Loris, SC
  • NPI 1265708119
  Medicare reassignment NPD
• McLeod Physician Associates II

  • Family Medicine Physician
  • Florence, SC
  • NPI 1801990494
  Medicare reassignment NPD
• McLeod Loris Seacoast Hospital

  • Community/Retail Pharmacy
  • Little River, SC
  • NPI 1629387352
  NPD
• McLeod Physician Associates II

  • Orthopaedic Surgery Physician
  • Florence, SC
  • NPI 1922555739
  NPD
• McLeod Regional Medical Center of the Pee Dee, Inc

  • Community/Retail Pharmacy
  • Florence, SC
  • NPI 1871775841
  NPD
• Columbus Regional Health Network

  • Family Medicine Physician
  • Whiteville, NC
  • NPI 1518263268
  NPD (past)

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

• Grand Strand Regional Medical Center LLC

  • General Acute Care Hospital
  • Myrlte Beach, SC
  • NPI 1083668669
  Care Compare affiliation
• McLeod Loris Seacoast Hospital

  • General Acute Care Hospital
  • Loris, SC
  • NPI 1306123344
  Care Compare affiliation
• McLeod Regional Medical Center of the Pee Dee, Inc.

  • General Acute Care Hospital
  • Florence, SC
  • NPI 1699756221
  Care Compare affiliation

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1710206909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 N 32ND ST STE 175",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183999",
            "telephone_number": "602-952-0002",
            "fax_number": "602-224-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 N 32ND ST STE 175",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183999",
            "telephone_number": "602-952-0002",
            "fax_number": "602-224-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEBAILY",
        "first_name": "NICHOLAS",
        "middle_name": "XAVIER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "49154",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2013-01215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710206909",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q0121S",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jdphysicaltherapy LLC
• JDS Home Care LLC
• Cassandra Jean Jean Lopez
• Alethea Jean Philippe, PT, DPT
• Aaliyah Jean
• Delaney Rae Jecmen
• Krista Marie Jeddi, FNP
• Roy Jedeikin, MD
• Caitlin Nicole Jefferis, MOT, OTR/L
• Alyssa Jeffers, RD

• Internal Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.