Jeffrey Michael Brock, M.D.
Individual provider Active NPI Family Medicine Physician · Cheraw, SC
NPI 1992966352 · NPPES record last updated Mar 20, 2024
Key facts
- NPI
- 1992966352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 31021 (SC)
- Practice address
- 812 State Rd
Cheraw, SC 29520-7113 - Phone
- (843) 537-0961
- Fax
- (843) 537-0908
- NPI assigned
- Jun 18, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Caresouth Carolina Inc.
Practice addresses (Care Compare)
3080 Hwy 15-401 E
MC Coll, SC 29570-6128
Phone (843) 523-5751
Hospital & facility affiliations
- Centerwell Home Health-Pee Dee
- Gentiva
- McLeod Health Cheraw
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120917000431 | SC | Practitioner - Family Practice | 5890943864 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301097004 | MI | MD | Family Medicine Physician |
| 31021 | SC | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caresouth Carolina, Inc. | Current | Accepting new patients | |
| Caresouth Carolina, Inc. | Current |
Accepting new patients | |
| Caresouth Carolina, Inc | Past | Accepting new patients | |
| Caresouth Carolina, Inc | Past | Accepting new patients | |
| Doctors Care, PA | Family Medicine | Past |
Accepting new patients |
Locations
545 Sumter Hwy
Bishopville, SC 29010
Phone (803) 484-5317
1268 S 4th St
Hartsville, SC 29550
Phone (843) 332-3422
3080 Highway 15-401 E
Mc Coll, SC 29570
Phone (843) 523-5751
Interoperability endpoints
- jeffrey.brock@csci.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301097004 | MI | |
| Family Medicine Physician | 207Q00000X | 31021 | SC | Yes |
Addresses
Primary practice location
812 State Rd
Cheraw, SC 29520-7113
Mailing address
PO Box 1090
Hartsville, SC 29551-1090
Phone (843) 857-0111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 310210 | Medicaid | SC |
Other providers in Cheraw, SC
- Bridges & James, Inc
- Bridges & James, Inc
- Bridges & James, Inc
- Jonathan Christopher Bridges
- Jonathan Cuentin Bridges
- Brothers of Peace, Inc
- Kwame Agyapong Brown
- Tracey Rogers Brunson
- Kay S. Bullard
- Ben E Burnett
All providers in Cheraw, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.