Individual provider Active NPI

Jesse Andrewe Raley, M.D.

  • Psychiatry Physician
  • Columbia, SC
National Provider Identifier
1851422422
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
27936 Issued in SC
Practice address
4500 Fort Jackson Blvd Ste 270
Columbia, SC 29209-1119
Phone
(803) 764-3555
Fax
(803) 764-4418
NPI assigned
Mar 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 27936 SC Primary

Addresses

Primary practice location

4500 Fort Jackson Blvd Ste 270
Columbia, SC 29209-1119

Mailing address

4500 Fort Jackson Blvd Ste 270
Columbia, SC 29209-1119
Phone (803) 764-3555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
27936SCMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Palmetto Psychiatry Consultants, LLC Psychiatry CurrentSince Jan 7, 2024 Accepting new patients

Locations

14 Monckton Blvd
Columbia, SC 29206
Phone (803) 238-5323

4500 Fort Jackson Blvd
Ste 270
Columbia, SC 29209
Phone (803) 764-3555

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1851422422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 FORT JACKSON BLVD STE 270",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292091119",
            "telephone_number": "803-764-3555",
            "fax_number": "803-764-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 FORT JACKSON BLVD STE 270",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292091119",
            "telephone_number": "803-764-3555",
            "fax_number": "803-764-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RALEY",
        "first_name": "JESSE",
        "middle_name": "ANDREWE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "27936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.