DR. JERRY G BACK (NPI# 1821181868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821181868 |
| Entity Type | Individual |
| Full Name | DR. JERRY G BACK |
| Credential | MD |
| Practice Address |
2845 Tricom St North Charleston SC 29406-9172 |
| Practice Telephone | 8438638100 |
| Practice Fax Number | 8435532122 |
| Mailing Telephone | 8438638100 |
| Mailing Fax Number | 8435532122 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2016-06-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 30658 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | MEDICARE GROUP NUMBER | C495158 | 01 |
| Street Address |
2845 TRICOM ST |
| City | NORTH CHARLESTON |
| State | SC |
| Zip Code | 29406-9172 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902233596 | Jeffery S Hover | Physician Assistant | 2845 Tricom St, North Charleston, SC 29406-9172 | 2013-09-27 |
| 1861569329 | Bonita A Spade | Nurse Practitioner | 2845 Tricom St, North Charleston, SC 29406-9172 | 2006-11-29 |
| 1326063629 | Deborah Mcgregor | Nurse Practitioner | 2845 Tricom St, North Charleston, SC 29406-9172 | 2006-07-13 |
| 1093773939 | Low Country Internal Medicine of Sc, P.a. | Internal Medicine | 2845 Tricom St, North Charleston, SC 29406-9172 | 2006-05-02 |
| 1487616454 | George E Minson | Internal Medicine | 2845 Tricom St, North Charleston, SC 29406-9172 | 2006-04-05 |
| 1336108943 | Nancy Elizabeth Crossley | Internal Medicine | 2845 Tricom St, North Charleston, SC 29406 | 2006-03-22 |
| 1639156094 | Stephen Patrick Hamm | Physician Assistant | 2845 Tricom St, North Charleston, SC 29406-9172 | 2005-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023622289 | Sara Desmarais | Physical Therapist | 2760 Tricom St, North Charleston, SC 29406 | 2020-09-04 |
| 1669036448 | Pink Elephant Autism Project | In Home Supportive Care | 8738 Red Oak Drive, Charleston, SC 29406 | 2019-04-26 |
| 1083171185 | Medical University Hospital Authority | Pharmacy | 2250 Mall Drive, North Charleston, SC 29406 | 2019-02-25 |
| 1336627371 | Truesdale Medical Center LLC | Internal Medicine | 6296 Rivers Ave., Suite 310, N. Charleston, SC 29406 | 2018-08-01 |
| 1164914552 | Amanda R Dipiazza | Nurse Anesthetist, Certified Registered | 9330 Medical Plaza Dr Ste E, Charleston, SC 29406 | 2018-06-01 |
| 1982148490 | Trident Medical Center | Psychiatric Hospital | 9225 C Medical Plaza Drive, Charleston, SC 29406 | 2016-12-19 |
| 1649726217 | First Choice Counseling Services, LLC | Community/Behavioral Health | 2245 Greenridge Rd., Unit#414, North Charleston, SC 29406 | 2016-09-01 |
| 1821443896 | Liberty Doctors, LLC | Family Medicine | 9275 D Medical Plaza Dr., North Charleston, SC 29406 | 2016-04-27 |
| 1174984645 | Ashia George | Developmental Therapist | 6650 Rivers Avenue, Ste 100, Charleston, SC 29406 | 2016-03-11 |
| 1023488582 | Etta Smith | Counselor | 2470 Mall Dr Unit Cd, North Charleston, SC 29406 | 2015-09-28 |
| Find all providers in zip 29406 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528345162 | Legacy Internal Medicine LLC | Internal Medicine | 9279 Medical Plaza Dr., Suite C, North Charleston, SC 29406 | 2011-11-10 |
| 1609168749 | Farhana Chaudhary | Internal Medicine | 9300 Medical Plaza Dr, North Charleston, SC 29406-9334 | 2011-05-09 |
| 1508165291 | Patrick Michael Looser | Internal Medicine | 4969 Centre Pointe Dr Ste 100, North Charleston, SC 29418 | 2011-03-21 |
| 1639486160 | Jared M Intaphan | Internal Medicine | 9150 Medcom St Ste B, North Charleston, SC 29406 | 2010-09-03 |
| 1205017860 | Hope Clinic LLC | Internal Medicine | 5880 Rivers Ave, North Charleston, SC 29406 | 2007-11-23 |
| 1194923094 | Shantae James Jenkins | Internal Medicine | 8471 Dorchester Rd, North Charleston, SC 29420-7381 | 2007-07-03 |
| 1275548067 | Andres J Arias | Internal Medicine | 2810 Ashley Phosphate Rd Ste B4, North Charleston, SC 29418-6406 | 2006-07-30 |
| 1023044245 | Tina M Botelho | Internal Medicine | 9275 Medical Plaza Dr Ste D, North Charleston, SC 29406-9140 | 2006-06-23 |
| 1295770436 | Eni Clement Okonofua | Internal Medicine | 5390 Dorchester Rd, North Charleston, SC 29418-5652 | 2006-06-19 |
| 1801831094 | Premier Internal Medicine, LLC | Internal Medicine | 9217 University Blvd, Suite C-1-d, North Charleston, SC 29406-9147 | 2006-06-19 |
| Find all providers in NORTH CHARLESTON | ||||
| City | NORTH CHARLESTON |
| Zip Code | 29406 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.