NPIMap

Individual provider Active NPI

Jay David Walls, MD

  • Hematology & Oncology Physician
  • Greenville, SC
National Provider Identifier
1821093956
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
17084 Issued in SC
Practice address
3 Butternut Dr
Ste B
Greenville, SC 29605-4653
Phone
(864) 241-7272
Fax
(864) 672-7852
NPI assigned
Jun 16, 2005
Last updated
Jun 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 17084 SC Primary

Addresses

Primary practice location

3 Butternut Dr
Ste B
Greenville, SC 29605-4653

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other identifiers 1

IdentifierTypeStateIssuer
N35782MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dvaz5511@direct.ghs.myhfn.org 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
I20100106000479 SC Practitioner - Medical Oncology 4284775701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical Oncology
Education
University of Tennessee, HSC, College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3 Butternut Dr
Suite B
Greenville, SC 29605-4653
Phone (864) 241-7272

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17084SCMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Jul 1, 2012 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Oncology and Hematology Associates of South Carolina, LLC Past Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

200 Andrews St
Greenville, SC 29601
Phone (864) 269-4508

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

3 Butternut Dr
Ste A
Greenville, SC 29605
Phone (864) 242-4320

3 Butternut Dr
Ste B
Greenville, SC 29605
Phone (864) 241-7272

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

325 Medical Pkwy
Ste 200
Greer, SC 29650
Phone (864) 241-7272

Interoperability endpoints

  • Direct secure messaging: jwalls31562@direct.ghs.myhfn.org

Organizations & group practices 3

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.

Hospital & facility affiliations 55

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

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1821093956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BUTTERNUT DR",
            "address_2": "STE B",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054653",
            "telephone_number": "864-241-7272",
            "fax_number": "864-672-7852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "JAY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "SC",
            "license": "17084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N35782",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dvaz5511@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "dvaz5511@direct.ghs.myhfn.org",
            "address_1": "3 Butternut Dr",
            "address_2": "Ste B",
            "city": "Greenville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296054653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.