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JACKSON DEREK HARTLEY M.D.
NPI 1104677202
Internal Medicine in Greenville, SC

Active since March 28, 2024PECOS Enrolled
876 W FARIS RD, GREENVILLE, SC 29605(864) 455-5648 Get Directions Write a Review

NPPES record last updated: August 9, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jackson Derek Hartley M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON DEREK HARTLEY M.D. (NPI 1104677202) is an individual internal medicine provider in Greenville, South Carolina, licensed in South Carolina (LL92431) and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104677202
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameJACKSON DEREK HARTLEYCredential: M.D.
Location Address876 W FARIS RDGreenville, SC 29605-4253
Mailing Address876 W Faris RdGreenville, SC 29605-4253
Phone(864) 455-5648
Sole ProprietorYes
Enumeration DateMarch 28, 2024
Last NPPES UpdateAugust 9, 2024
NPPES CertifiedAugust 9, 2024
✔ NPI 1104677202 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in SC · LL92431
Definition
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.
876 W FARIS RD, Greenville, SC 29605
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackson Derek Hartley M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29605 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$124.04 typical visit price
range $53.57 – $163.84
Typical copayment $31.01 (range $13.39 – $40.96)
Most-billed visit code 99204
Established Patient
$95.12 typical visit price
range $16.96 – $133.52
Typical copayment $23.78 (range $4.24 – $33.38)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HILARY LAUREN KNIPPERS DO
Internal Medicine
876 W FARIS RD
GREENVILLE, SC 29605
Greenville County (864) 455-5648
DANTE TERRACCIANO MD
Emergency Medicine
876 W FARIS RD
GREENVILLE, SC 29605
Greenville County (864) 455-5648
KATELYN E DRULARD LMSW
Social Worker
876 W FARIS RD
GREENVILLE, SC 29605
Greenville County (704) 575-8529
CHRISTOPHER CACCIATORE DO
Emergency Medicine
876 W FARIS RD
GREENVILLE, SC 29605
Greenville County (864) 455-5648
EMILY CLEVELAND DO, MPH
Emergency Medicine
876 W FARIS RD
GREENVILLE, SC 29605
Greenville County (864) 455-5648
BONNIE SUE KENNEDY MD
Internal Medicine
876 W FARIS RD
GREENVILLE, SC 29605
Greenville County (864) 455-5648
MEGHAN FILSON DO
Emergency Medicine (Emergency Medical Services)
876 W FARIS RD
GREENVILLE, SC 29605
Greenville County (864) 455-5648
MARIA HERRAN MONTES
Student in an Organized Health Care Education/Training Program
876 W FARIS RD
GREENVILLE, SC 29605
Greenville County (864) 455-5648

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Hartley's NPI number?

The NPI number for Jackson Hartley is 1104677202. It was assigned to this individual provider in the NPPES registry on March 28, 2024.

Where is Jackson Hartley located?

Jackson Hartley practices at 876 W Faris Rd, Greenville, SC 29605. The listed phone number is (864) 455-5648.

What is Jackson Hartley's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Jackson Hartley enrolled in Medicare?

Yes. Jackson Hartley is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jackson Hartley was last updated on August 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.