Jerry G Back, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

30658 Issued in SC

Practice address

2845 Tricom St
North Charleston, SC 29406-9172

Phone

(843) 863-8100

Fax

(843) 553-2122

NPI assigned

Oct 2, 2006

Last updated

Jan 14, 2022By 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

Electronic endpoints 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

Specialty

Internal Medicine

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

East Cooper Physician Group LLCGroup PAC ID 1254775687, 126 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trident Medical Center Hospital, Charleston, SC, CCN 420079
• Novant Health East Cooper Medical Center Hospital, Mount Pleasant, SC, CCN 420089

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jerry.back.1@30548.direct.athenahealth.com

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.

• East Cooper Physician Group LLC

  • Internal Medicine Physician
  • Daniel Island, SC
  • NPI 1861253981
  Medicare reassignment Care Compare group NPD
• East Cooper Physician Group LLC

  dba Hand Institute of Charleston

  • Orthopaedic Surgery Physician
  • Summerville, SC
  • NPI 1437910569
  NPD
• East Cooper Physician Group LLC

  dba Novant Health Diagnostic Imaging at East Cooper

  • Body Imaging Physician
  • Mount Pleasant, SC
  • NPI 1699641571
  NPD
• East Cooper Physician Group LLC

  dba High Tide Internal Medicine - East Cooper Medical Group

  • Internal Medicine Physician
  • Summerville, SC
  • NPI 1982475604
  NPD (past)
• Healthone Clinic Services - Primary Care LLC

  • Family Medicine Physician
  • Denver, CO
  • NPI 1518141761

  Internal Medicine

  NPD (past)
• Indiana University Health la Porte Hospital Inc

  • General Acute Care Hospital
  • La Porte, IN
  • NPI 1386822989
  NPD (past)

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

• East Cooper Medical Center LLC

  dba Novant Health East Cooper Medical Center

  • General Acute Care Hospital
  • Mount Pleasant, SC
  • NPI 1841069044
  Care Compare affiliation
• Trident Medical Center, LLC

  dba HCA Healthcare Trident Hospital

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1366496937
  Care Compare affiliation

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642118400000",
    "number": "1821181868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069172",
            "telephone_number": "843-863-8100",
            "fax_number": "843-553-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 TRICOM ST",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069172",
            "telephone_number": "843-863-8100",
            "fax_number": "843-553-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACK",
        "first_name": "JERRY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2022-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "30658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "C495158",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JERRY.BACK@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "2845 Tricom St",
            "city": "North Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294069172",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brae-Elise Ayers
• Kristina Leone Ayers, MSR, CCC-SLP
• Henry Ayiku, MD
• Ayu Surgical Specialists LLC
• Lauren Babb
• Brooke Bae, RN
• Emily A Bagwell, P.A.
• Helen Marie Bailey, RN
• Jessica Bailey, OTR/L
• Karl Bailey, DC

• Internal Medicine Physician in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.