NPIMap

Individual provider Active NPI

William A. Jackson Jr., MD

  • Cardiovascular Disease Physician
  • Myrtle Beach, SC
National Provider Identifier
1760471130
Registry record updated Jan 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
21136 Issued in SC
Practice address
945 82ND Pkwy
Ste 3B
Myrtle Beach, SC 29572-4612
Phone
(843) 839-1201
Fax
(843) 839-1202
NPI assigned
Oct 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 21136 SC Primary

Addresses

Primary practice location

945 82ND Pkwy
Ste 3B
Myrtle Beach, SC 29572-4612

Mailing address

PO Box 3239
Florence, SC 29502-3239
Phone (843) 839-1201

Other identifiers 1

IdentifierTypeStateIssuer
211363MedicaidSC

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
I20040521001107 SC Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0244221778 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Medical University of South Carolina College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 McLeod Health Blvd
Suite 201
Myrtle Beach, SC 29579-4477
Phone (843) 646-8001

107 McLeod Health Blvd
Myrtle Beach, SC 29579-4477

3485 Mitchell St
Loris, SC 29569-2823
Phone (843) 756-7029

3781 McDowell Lane
Suite 200
Little River, SC 29566-7833
Phone (843) 366-3891

3793 McDowell LN
Suite 200
Little River, SC 29566-7892
Phone (843) 390-0877

4000 Hwy 9 E
Suite 250
Little River, SC 29566-7833
Phone (843) 366-3891

555 E Cheves St
Florence, SC 29506-2617
Phone (843) 777-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21136SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Loris Seacoast Hospital CurrentSince Jun 1, 2022 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince Sep 15, 2024 Accepting new patients
McLeod Physician Associates II CurrentSince Oct 1, 2016 Accepting new patients
McLeod Physician Associates II CurrentSince Oct 1, 2016 Accepting new patients
McLeod Loris Seacoast Hospital CurrentSince Jun 1, 2022 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince Sep 15, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
McLeod Physician Associates II Cardiovascular Disease Past Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc Cardiovascular Disease Past Accepting new patients

Locations

800 E Cheves St
Ste 480A
Florence, SC 29506
Phone (843) 777-7337

800 E Cheves St
Ste 240
Florence, SC 29506
Phone (843) 777-7950

555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233

3793 McDowell Ln
Ste 200
Little River, SC 29566
Phone (843) 390-0877

3655 Mitchell St
Loris, SC 29569
Phone (843) 716-7000

3485 Mitchell St
Loris, SC 29569
Phone (843) 390-0877

945 82nd Pkwy
Ste 3
Myrtle Beach, SC 29572
Phone (843) 449-3381

Interoperability endpoints

  • Direct secure messaging: wjackson30191@directmcleodehealth.org

Organizations & group practices 9

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484870400000",
    "number": "1760471130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3239",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295023239",
            "telephone_number": "843-839-1201",
            "fax_number": "843-839-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "945 82ND PKWY",
            "address_2": "STE 3B",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724612",
            "telephone_number": "843-839-1201",
            "fax_number": "843-839-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "WILLIAM",
        "middle_name": "A.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2017-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SC",
            "license": "21136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211363",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.