Active NPI
Jeremy W Young, MD
- Diagnostic Radiology Physician
- Orangeburg, SC
National Provider Identifier
1912958950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 16936
- Practice address
- 3000 Saint Matthews Rd
Orangeburg, SC 29118-1442 - Phone
- (803) 395-2200
- Fax
- (803) 536-0998
- NPI assigned
- May 15, 2006
- 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 16936 | SC | Primary |
Addresses
Primary practice location
3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Mailing address
PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-2200
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LL1020 | Medicaid | SC | |
| 400685 | Medicaid | SC | |
| GP1426 | Medicaid | SC |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16936 | SC | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Palmetto Vascular Diagnostic LLC | Diagnostic Radiology | Past | Accepting new patients |
| Disc Radiologists PA | Diagnostic Radiology | Past | Accepting new patients |
| Disc Diagnostics | Diagnostic Radiology | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Diagnostic Radiology Physician
- Orangeburg, SC
- NPI 1013944206
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344384000000",
"number": "1912958950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1245",
"city": "ORANGEBURG",
"state": "SC",
"postal_code": "291161245",
"telephone_number": "803-395-2200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 SAINT MATTHEWS RD",
"city": "ORANGEBURG",
"state": "SC",
"postal_code": "291181442",
"telephone_number": "803-395-2200",
"fax_number": "803-536-0998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "JEREMY",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2012-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "SC",
"license": "16936",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LL1020",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "400685",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP1426",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orangeburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.