Active NPI
Jerry S. Purcell, M.D.
- Family Medicine Physician
- Anderson, SC
National Provider Identifier
1881657153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 21864
- Practice address
- 1208 Ella St
Anderson, SC 29621-4839 - Phone
- (864) 965-9150
- Fax
- (864) 965-9654
- NPI assigned
- Apr 8, 2006
- Last updated
- Aug 7, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 21864 | SC | Primary |
Addresses
Primary practice location
1208 Ella St
Anderson, SC 29621-4839
Mailing address
1208 Ella St
Anderson, SC 29621-4839
Phone (864) 965-9150
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 967617053A | Medicaid | GA | |
| 5901065 | Medicaid | NC | |
| 218641 | Medicaid | SC |
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
- Opted out of Medicare
- Yes, effective Jan 11, 2014 through Jan 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21864 | SC | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596758400000",
"number": "1881657153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1208 ELLA ST",
"city": "ANDERSON",
"state": "SC",
"postal_code": "296214839",
"telephone_number": "864-965-9150",
"fax_number": "864-659-6549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1208 ELLA ST",
"city": "ANDERSON",
"state": "SC",
"postal_code": "296214839",
"telephone_number": "864-965-9150",
"fax_number": "864-965-9654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PURCELL",
"first_name": "JERRY",
"middle_name": "S.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-08",
"last_updated": "2020-08-07",
"certification_date": "2020-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "21864",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "967617053A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5901065",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "218641",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anderson, SC
- Publix Super Markets Inc (Publix Pharmacy #0563)
- Publix Super Markets Inc (Publix Pharmacy #0360)
- Chelsea Puckett, ATC
- Makeela Puckett
- Joseph William Pullekines, MD
- John H Purcell, MD
- Jeanne Olson Quam, MT-BC
- Mark Johnson Quarterman, MD
- Stephen Adrian Quarterman, PA
- Quest Diagnostics Clinical Laboratories Inc (Labtech Diagnostics)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.