NPIMap

Individual provider Active NPI

Robert E Jackson Jr., MD

  • Family Medicine Physician
  • Gaffney, SC
National Provider Identifier
1710965637
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10879 Issued in SC
Practice address
517 Chesnee Hwy Ste a
Gaffney, SC 29341-2709
Phone
(864) 487-7655
Fax
(864) 487-7818
NPI assigned
Jan 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 10879 SC Primary

Addresses

Primary practice location

517 Chesnee Hwy Ste a
Gaffney, SC 29341-2709

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
SCG5856067OtherSCMEDICARE PIN
018797MedicaidSC
SCG5856084OtherSCMEDICARE PIN
SCG585J577OtherSCMEDICARE PIN
080075169OtherRR MCR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rjackson36883@direct-srhs.et0939.epichosted.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
I20041203000397 SC Practitioner - Family Practice 5890751614 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherokee Medical CenterGroup PAC ID 5991041212, 38 clinicians

Practice addresses (Care Compare)

517 Chesnee Hwy
Suite a
Gaffney, SC 29341-2709
Phone (864) 487-7655

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Gaffney, SC, CCN 427117
  • Centerwell Home Health Home health agency, Greenville, SC, CCN 427017
  • Cherokee Medical Center Hospital, Gaffney, SC, CCN 420043
  • Spartanburg Medical Center Hospital, Spartanburg, SC, CCN 420007
  • Pelham Medical Center Hospital, Greer, SC, CCN 420103

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Family Medicine CurrentSince Nov 23, 2019 Accepting new patients
Cherokee Medical Center Family Medicine Current Accepting new patients
Westgate Family Physicians PA Family Medicine CurrentSince Jan 2, 1996 Accepting new patients
Spartanburg Medical Center Family Medicine Current Accepting new patients
Spartanburg Medical Center CurrentSince Nov 23, 2019 Accepting new patients
Cherokee Medical Center Family Medicine CurrentSince Oct 1, 2019 Accepting new patients
Cherokee Medical Center CurrentSince Oct 1, 2019 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Nov 23, 2019 Accepting new patients
Upstate Carolina Radiology PA Past Accepting new patients

Locations

840 W Floyd Baker Blvd
Gaffney, SC 29341
Phone (864) 489-3300

517 Chesnee Hwy
#A
Gaffney, SC 29341
Phone (864) 487-7655

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

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

2995 Reidville Rd
Ste 100
Spartanburg, SC 29301
Phone (864) 587-3000

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

105 Powell Mill Rd
Spartanburg, SC 29301
Phone (864) 574-0070

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

Interoperability endpoints

  • Direct secure messaging: robertjackson@wfpsc.allscriptsdirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1710965637",
    "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": "517 CHESNEE HWY STE A",
            "city": "GAFFNEY",
            "state": "SC",
            "postal_code": "293412709",
            "telephone_number": "864-487-7655",
            "fax_number": "864-487-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROBERT",
        "middle_name": "E",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "10879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCG5856067",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018797",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCG5856084",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "SCG585J577",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "080075169",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rjackson36883@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "rjackson36883@direct-srhs.et0939.epichosted.com",
            "address_1": "517 Chesnee Hwy Ste A",
            "city": "Gaffney",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293412709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gaffney, SC

Sources for this page

Verify at the official NPI Registry.