Active NPI
Jacob Moore
- Psychiatry Physician
- Greer, SC
National Provider Identifier
1861333163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- LL97102
- Practice address
- 109 Physicians Dr
Greer, SC 29650-2446 - Phone
- (864) 797-9171
- NPI assigned
- Apr 2, 2026
- Last updated
- Jul 16, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | LL97102 | SC | Primary |
Addresses
Primary practice location
109 Physicians Dr
Greer, SC 29650-2446
Mailing address
109 Physicians Dr
Greer, SC 29650-2446
Phone (864) 797-9171
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1775088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784160000000",
"number": "1861333163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 PHYSICIANS DR",
"city": "GREER",
"state": "SC",
"postal_code": "296502446",
"telephone_number": "864-797-9171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 PHYSICIANS DR",
"city": "GREER",
"state": "SC",
"postal_code": "296502446",
"telephone_number": "864-797-9171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-04-02",
"last_updated": "2026-07-16",
"certification_date": "2026-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "SC",
"license": "LL97102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greer, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; 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.