Individual provider Active NPI

Jeffrey Julian Del Real, PA-C

  • Physician Assistant
  • Simpsonville, SC
National Provider Identifier
1942655303
Registry record updated Nov 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
35 Ray E Talley CT
Simpsonville, SC 29680-6772
Phone
(864) 967-7028
Fax
(864) 228-0915
NPI assigned
May 3, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

35 Ray E Talley CT
Simpsonville, SC 29680-6772

Mailing address

PO Box 749306
Atlanta, GA 30374-9306
Phone (864) 967-7028

Other practice location 1

832 Powdersville Rd
Easley, SC 29642-3706
Phone (648) 593-8998

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220323001713 SC Practitioner - Physician Assistant 1850786120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Urgent Cares LLCGroup PAC ID 8628502598, 183 clinicians

Practice addresses (Care Compare)

6167 Braided Mane Pass SW
Aiken, SC 29803-7839
Phone (803) 648-1464

793 E Butler Rd
Mauldin, SC 29662-3223
Phone (864) 720-1442

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4225SCMDDentist

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": "1462233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730592000000",
    "number": "1942655303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749306",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749306",
            "telephone_number": "864-967-7028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 RAY E TALLEY CT",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296806772",
            "telephone_number": "864-967-7028",
            "fax_number": "864-228-0915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "832 Powdersville Rd",
            "address_purpose": "LOCATION",
            "city": "Easley",
            "state": "SC",
            "postal_code": "296423706",
            "country_code": "US",
            "telephone_number": "648-593-8998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEL REAL",
        "first_name": "JEFFREY",
        "middle_name": "JULIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-03",
        "last_updated": "2024-11-03",
        "certification_date": "2024-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simpsonville, SC

Sources for this page

Verify at the official NPI Registry.