NPIMap

Individual provider Active NPI

Jessica Gonzalez Hernandez, MD

  • Surgery Physician
  • Greenville, SC
National Provider Identifier
1962792580
Registry record updated Feb 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
61156 Issued in SC
Practice address
Carolina Surgical Associates Eastside
135 Commonwealth Drive Ste 210
Greenville, SC 29615-4850
Phone
(864) 675-4815
Fax
(877) 893-3779
NPI assigned
Apr 15, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 61156 SC Primary

Addresses

Primary practice location

Carolina Surgical Associates Eastside
135 Commonwealth Drive Ste 210
Greenville, SC 29615-4850

Mailing address

PO Box 743294
Atlanta, GA 30374-3294
Phone (787) 349-0120

Other identifiers 1

IdentifierTypeStateIssuer
611564MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170822001184 TX Practitioner - General Surgery 9133418718 Reassigns benefits to 1 organization
I20181214000689 SC Practitioner - General Surgery 9133418718 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Puerto Rico School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 Saint Francis Dr
Greenville, SC 29601-3955
Phone (513) 853-8520

125 Commonwealth Dr
Greenville, SC 29615-4812
Phone (864) 675-4000

135 Commonwealth Dr
Greenville, SC 29615-4850

317 Saint Francis Dr
Suite 220
Greenville, SC 29601-3976
Phone (864) 255-1901

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)14
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61156SCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Aug 1, 2017 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Surgery CurrentSince Aug 1, 2017 Accepting new patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 21, 2022 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Bon Secours Medical Group Greenville Specialty Care LLC Surgery CurrentSince May 21, 2022 Accepting new patients
St Francis Physician Services Inc Surgery Past Accepting new patients

Locations

317 Saint Francis Dr
Ste 220
Greenville, SC 29601
Phone (864) 255-1901

135 Commonwealth Dr
Ste 210
Greenville, SC 29615
Phone (864) 242-1750

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Interoperability endpoints

  • Direct secure messaging: jgonzalezhernandez1151503@direct.bsmhealth.org

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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": "1302825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550620800000",
    "number": "1962792580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743294",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743294",
            "telephone_number": "787-349-0120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CAROLINA SURGICAL ASSOCIATES EASTSIDE",
            "address_2": "135 COMMONWEALTH DRIVE STE 210",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154850",
            "telephone_number": "864-675-4815",
            "fax_number": "877-893-3779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ HERNANDEZ",
        "first_name": "JESSICA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-15",
        "last_updated": "2019-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "61156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "611564",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.