Jack Wilson Cleland, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

30778 Issued in SC

Practice address

1330 Boiling Springs Rd
Suite 1300
Spartanburg, SC 29303-4201

Phone

(864) 560-6345

Fax

(864) 560-6054

NPI assigned

Jun 2, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jcleland40508@direct-srhs.et0939.epichosted.com

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.

• Cherokee Medical Center

  • Family Medicine Physician
  • Gaffney, SC
  • NPI 1285275305
  Medicare reassignment NPD
• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217

  Pediatrics

  Medicare reassignment NPD
• Spartanburg Medical Center

  • Neuromusculoskeletal Medicine & OMM Physician
  • Spartanburg, SC
  • NPI 1043309917
  Medicare reassignment NPD
• Cherokee Medical Center

  • Rural Health Clinic/Center
  • Gaffney, SC
  • NPI 1265073381

  Pediatrics

  NPD
• Cherokee Medical Center

  • Pediatrics Physician
  • Gaffney, SC
  • NPI 1851942346
  NPD
• Prisma Health University Medical Group

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD
• Prisma Health University Medical Group

  • Nurse Practitioner
  • Greenville, SC
  • NPI 1053786483
  NPD
• Spartanburg Medical Center

  • Pediatrics Physician
  • Lyman, SC
  • NPI 1467851006
  NPD
• Spartanburg Medical Center

  • Physical Medicine & Rehabilitation Physician
  • Spartanburg, SC
  • NPI 1942188875
  NPD
• Spartanburg Medical Center

  • Obstetrics & Gynecology Physician
  • Spartanburg, SC
  • NPI 1376580852
  NPD (past)

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1912166315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 BOILING SPRINGS RD",
            "address_2": "SUITE 1300",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293034201",
            "telephone_number": "864-560-6345",
            "fax_number": "864-560-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLELAND",
        "first_name": "JACK",
        "middle_name": "WILSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-02",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL30778",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "30778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307787",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcleland40508@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jcleland40508@direct-srhs.et0939.epichosted.com",
            "address_1": "1330 Boiling Springs Rd",
            "address_2": "Suite 1300",
            "city": "Spartanburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293034201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christina Mareno Clay, PA
• Bethany Claytor
• CLC Administrative Services, Inc.
• Adreon Alexis Clea
• Hailey Cleary
• Madison Clements, DO
• Blair Wetmore Clementson, M.D.
• Brittney Lynn Clemmer, NP
• Jane T Clemmer, LMSW
• Kancy Cleveland, LPC

• Pediatrics Physician in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.