Individual provider Active NPI

Julia Jaskwhich Rodriguez, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Charleston, SC
National Provider Identifier
1295974616
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4422 Issued in SC
Practice address
1616 Ashley River Rd
Charleston, SC 29407-5902
Phone
(843) 556-9177
Fax
(843) 571-2742
NPI assigned
Feb 9, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN109735 SC
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4422 SC Primary

Addresses

Primary practice location

1616 Ashley River Rd
Charleston, SC 29407-5902

Mailing address

1620 Ashley River Rd
Building J
Charleston, SC 29407-5902
Phone (843) 556-8177

Other identifiers 1

IdentifierTypeStateIssuer
1760596480MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120306000928 SC Practitioner - Nurse Practitioner 5698934933 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Charleston Counseling Center PCGroup PAC ID 6204125107, 186 clinicians

Practice addresses (Care Compare)

30 Patewood Dr
Suite 160
Greenville, SC 29615-6809
Phone (843) 501-1099

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN109735SCMDRegistered Nurse
4422SCMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Counseling Center PC CurrentSince Jul 22, 2024 Accepting new patients
Myrtle Beach Counseling Center PastSince Aug 6, 2019 Accepting new patients
Charleston Family Center, LLC PastSince Dec 1, 2012 Accepting new patients

Locations

30 Patewood Dr
Ste 160
Greenville, SC 29615
Phone (864) 455-5777

871 Lowcountry Blvd
Ste 200
Mt Pleasant, SC 29464
Phone (253) 346-0137

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.juliarodriguez@149035.advancedmd-direct.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1234137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1295974616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 ASHLEY RIVER RD",
            "address_2": "BUILDING J",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075902",
            "telephone_number": "843-556-8177",
            "fax_number": "843-571-2742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 ASHLEY RIVER RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075902",
            "telephone_number": "843-556-9177",
            "fax_number": "843-571-2742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "JULIA",
        "middle_name": "JASKWHICH",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-09",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "RN109735",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SC",
            "license": "4422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760596480",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.