Jerry G Back (NPI# 1821181868, PAC ID# 6002910064) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1821181868 |
| PAC ID by PECOS | 6002910064 |
| Professional Enrollment ID | I20090311000240 |
| Full Name | Jerry G Back |
| Organization Legal Name | COASTAL CAROLINA PRIMARY CARE, LLC |
| Address |
2845 Tricom St North Charleston SC 29406-9172 |
| Phone Number | 8438638100 |
| Gender | M |
| Credential | MD |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 3577629088 |
| Number of Group Practice Members | 45 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 420079 | TRIDENT MEDICAL CENTER |
| 420004 | MUSC MEDICAL CENTER |
| 420030 | COLLETON MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 809 82nd Pkwy, Myrtle Beach, SC 29572-4607 | 8432917182 | COASTAL CAROLINA PRIMARY CARE, LLC |
| 2845 Tricom St, North Charleston, SC 29406-9172 | 8438638100 | COASTAL CAROLINA PRIMARY CARE, LLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PHCDRR_1 | Immunization Registry Reporting | % | |
| ACI_EC_TRANS_PHCDRR_3 | Specialized Registry Reporting | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % |
| Organization Legal Name | COASTAL CAROLINA PRIMARY CARE, LLC |
| Physicians | 39 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Anthony L Shadiack | Family Medicine | Coastal Carolina Primary Care, LLC | 839 82nd Pkwy, Myrtle Beach, SC 29572-4614 |
| Nancy Burgess Stroud | Obstetrics/gynecology | Coastal Carolina Primary Care, LLC | 9279 Medical Plaza Dr, Suite A, Charleston, SC 29406-9141 |
| Alexander W Chessman | Family Medicine | Coastal Carolina Primary Care, LLC | 9228 Medical Plaza Dr, Charleston, SC 29406-9125 |
| Susan K Herrington | Physician Assistant | Coastal Carolina Primary Care, LLC | 9221 University Blvd, Suite 102, North Charleston, SC 29406-9148 |
| Sarah E Hearn | Physician Assistant | Coastal Carolina Primary Care, LLC | 295 Midland Pkwy, Summerville, SC 29485-8104 |
| Nicholas P Shungu | Family Medicine | Coastal Carolina Primary Care, LLC | 809 82nd Pkwy, Myrtle Beach, SC 29572-4607 |
| Sean Patrick Haley | Family Medicine | Coastal Carolina Primary Care, LLC | 9228 Medical Plaza Dr, Charleston, SC 29406-9125 |
| Eric M Matheson | Family Medicine | Coastal Carolina Primary Care, LLC | 9228 Medical Plaza Dr, Charleston, SC 29406-9125 |
| Kristen L Hood Watson | Family Medicine | Coastal Carolina Primary Care, LLC | 9228 Medical Plaza Dr, Charleston, SC 29406-9125 |
| Kevin W Shea | Infectious Disease | Coastal Carolina Primary Care, LLC | 8170 Rourk St, Suite 100, Myrtle Beach, SC 29572-4127 |
| Street Address |
2845 TRICOM ST |
| City | NORTH CHARLESTON |
| State | SC |
| Zip | 29406-9172 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mark A Coker | Cardiovascular Disease (cardiology) | Palmetto Primary Care Physicians | 2550 Elms Ctr Rd, N Charleston, SC 29406 |
| Mary L Bowen | Nurse Practitioner | Palmetto Primary Care Physicians | 2550 Elms Ctr Rd, N Charleston, SC 29406 |
| Jason B Coker | Internal Medicine | Palmetto Primary Care Physicians | 2550 Elms Ctr Rd, N Charleston, SC 29406 |
| Dana West | Nurse Practitioner | Palmetto Primary Care Physicians | 2550 Elms Ctr Rd, N Charleston, SC 29406 |
| Victoria M Adams | Nurse Practitioner | Palmetto Primary Care Physicians | 2550 Elms Ctr Rd, N Charleston, SC 29406 |
| Kirsten Lynn Paris | Physician Assistant | Palmetto Primary Care Physicians | 2550 Elms Ctr Rd, North Charleston, SC 29406 |
| Jack Stansbury | Nurse Practitioner | Palmetto Primary Care Physicians | 2550 Elms Ctr Rd, N Charleston, SC 29406 |
| Jennifer M Lesslie | Optometry | 1370 Remount Rd, Suite B, N Charleston, SC 29406-3322 | |
| Francis Akom | Obstetrics/gynecology | 1370 Remount Rd D, North Charleston, SC 29406-3322 | |
| Michael David Schall | Optometry | 1415 Remount Rd, N Charleston, SC 29406-3326 | |
| Find all physicians in zip 29406 | |||
| City | NORTH CHARLESTON |
| Zip Code | 29406 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | NORTH CHARLESTON + INTERNAL MEDICINE |
Please comment or provide details below to improve the information on Jerry G Back.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.