Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

JACK DOUGLAS SUDDUTH MD, MS
NPI 1215632898
Anesthesiology - Critical Care Medicine in Charleston, SC

Q: What is Jack Sudduth's NPI number?

The NPI number for Jack Sudduth is 1215632898. It was assigned to this individual provider in the NPPES registry on April 3, 2023.

Q: What is Jack Sudduth's specialty?

The primary specialty registered for this NPI is Anesthesiology, specializing in Critical Care Medicine, with taxonomy code 207LC0200X.

Q: When was this NPI record last updated?

The NPPES record for Jack Sudduth was last updated on August 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 days 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.

Active since April 03, 2023PECOS Enrolled

169 ASHLEY AVE RM 202, CHARLESTON, SC 29425(843) 876-6983 Get Directions Write a Review

NPPES record last updated: August 1, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Jack Douglas Sudduth Md, Ms NPPES

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

JACK DOUGLAS SUDDUTH MD, MS (NPI 1215632898) is an individual critical care medicine provider in Charleston, South Carolina, licensed in South Carolina (97057) and active in the NPI registry since April 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1215632898

Entity TypeIndividualMale

Primary Taxonomy207LC0200X

Provider Legal NameJACK DOUGLAS SUDDUTHCredential: MD, MS

Location Address169 ASHLEY AVE RM 202Charleston, SC 29425-8905

Mailing Address169 Ashley Ave Rm 202Charleston, SC 29425-8905

Phone(843) 876-6983

Sole ProprietorYes

Enumeration DateApril 3, 2023

Last NPPES UpdateAugust 1, 2026

NPPES CertifiedAugust 1, 2026

✔ NPI 1215632898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiology · Critical Care MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207LC0200X

License✔ Licensed in SC · 97057

Definition

An anesthesiologist, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.

169 ASHLEY AVE RM 202, Charleston, SC 29425

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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)

Jack Douglas Sudduth Md, Ms 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.

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

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