Johnnie Jacqueline Wren, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

307989 Issued in NY

Practice address

15 Pleasant Street
Au Sable Forks, NY 21912

Phone

(518) 647-8164

NPI assigned

Mar 31, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Wind Primary Care PLLCGroup PAC ID 4587066956, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCR / HCR Home Care Chha (Plattsburgh) Home health agency, Plattsburgh, NY, CCN 337024
• Hospice of the North Country Inc Hospice, Plattsburgh, NY, CCN 331528
• The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwren@northwindprimarycare.medentdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Wind Primary Care PLLC

  • Internal Medicine Physician
  • Plattsburgh, NY
  • NPI 1629646690
  Medicare reassignment Care Compare group NPD
• Champlain Valley Physicians Hospital Medical Center

  • Internal Medicine Physician
  • Plattsburgh, NY
  • NPI 1124189782

  Family Medicine

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Champlain Valley Physicians Hospital Medical Center

  • General Acute Care Hospital
  • Plattsburgh, NY
  • NPI 1033270699
  Care Compare affiliation
• Hospice of the North Country, Inc

  • Community Based Hospice Care Agency
  • Plattsburgh, NY
  • NPI 1417999053
  Care Compare affiliation
• L Woerner Inc

  • Home Health Agency
  • Plattsburgh, NY
  • NPI 1013354539
  Care Compare affiliation
• L Woerner Inc

  • Home Health Agency
  • Plattsburgh, NY
  • NPI 1215203740
  Care Compare affiliation
• L Woerner Inc

  • Home Health Agency
  • Plattsburgh, NY
  • NPI 1588938864
  Care Compare affiliation
• L Woerner Inc

  • Home Health Agency
  • Oneonta, NY
  • NPI 1649575549
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1073045746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 MARGARET ST",
            "address_2": "SUITE 100",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011893",
            "telephone_number": "518-314-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PLEASANT STREET",
            "city": "AU SABLE FORKS",
            "state": "NY",
            "postal_code": "21912",
            "telephone_number": "518-647-8164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WREN",
        "first_name": "JOHNNIE",
        "middle_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-31",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "307989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06303951",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Peter Najim, DDS
• Laurel M Rosenthal, MD
• George Sarandev, DDS
• Kasey Snow
• Terry Jane Walters, MD

• Family Medicine Physician in Au Sable Forks, NY
• Providers in Au Sable Forks, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.