Charles West Jacocks IV, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

14114 Issued in SC

Practice address

2300 Ramsey St RM 304-a
Fayetteville, NC 28301-3856

Phone

(910) 488-2120

NPI assigned

Feb 8, 2006

Last updated

Jul 31, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Prisma Health Tuomey

  dba Prisma Health Emergency Physicans Tuomey

  • Emergency Medicine Physician
  • Sumter, SC
  • NPI 1548625593

  Cardiovascular Disease

  Medicare reassignment NPD
• Prisma Health Tuomey

  dba Prisma Health Tuomey Acute Rehabilitation

  • Rehabilitation Hospital Unit
  • Sumter, SC
  • NPI 1609895663
  NPD

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1720051105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 RAMSEY ST RM 304-A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283013856",
            "telephone_number": "910-488-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 RAMSEY ST RM 304-A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283013856",
            "telephone_number": "910-488-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOCKS",
        "first_name": "CHARLES",
        "middle_name": "WEST",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SC",
            "license": "14114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141144",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christian Jacobs
• Esther Jacobs
• Leon Jacobs, M.ED
• Olivia Shea Jacobson, MA, CCC-SLP
• Sarah Elizabeth Jacobson, DO
• Jactom Inc (Bethesda Health Care)
• Jagdish Lal MD PA (Rayconda Internal Medicine)
• Tahmida Jahangir, MD
• Haja Jallow-Konrat
• James D Douglass DDS PA

• Cardiovascular Disease Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Cardiovascular Disease Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.