Individual provider Active NPI

Deann Wybenga Jebaily, D.O.

  • Family Medicine Physician
  • Florence, SC
National Provider Identifier
1952530982
Registry record updated Jul 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
LL4759 Issued in SC
Practice address
555 E Cheves St
Florence, SC 29506-2617
Phone
(843) 777-2800
Fax
(843) 777-2810
NPI assigned
Jul 13, 2009
Last updated
Jul 13, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X LL4759 SC Primary

Addresses

Primary practice location

555 E Cheves St
Florence, SC 29506-2617

Mailing address

PO Box 100551
Florence, SC 29502-0551
Phone (843) 777-2800

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110311000618 SC Practitioner - Family Practice 5597947564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

555 E Cheves St
Florence, SC 29506-2617
Phone (843) 777-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
LL4759SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Regional Medical Center of the Pee Dee, Inc Family Medicine CurrentSince Jul 15, 2011 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc CurrentSince Jul 15, 2011 Accepting new patients
McLeod Regional Medical Center of the Pee Dee, Inc. Past Accepting new patients

Locations

144 N Ravenel St
Florence, SC 29506
Phone (843) 777-2566

555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233

Interoperability endpoints

  • Direct secure messaging: djebaily19478@directmcleodehealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247443200000",
    "number": "1952530982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100551",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295020551",
            "telephone_number": "843-777-2800",
            "fax_number": "843-777-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E CHEVES ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062617",
            "telephone_number": "843-777-2800",
            "fax_number": "843-777-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEBAILY",
        "first_name": "DEANN",
        "middle_name": "WYBENGA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-13",
        "last_updated": "2009-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LL4759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.