Active NPI
Allen Richard Wenner, M.D.
- Family Medicine Physician
- Lexington, SC
National Provider Identifier
1316006760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 07472
- Practice address
- 4711 Sunset Blvd
Agape Physicians Care
Lexington, SC 29072-9151 - Phone
- (803) 356-3609
- Fax
- (803) 451-6135
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 07472 | SC | Primary |
Addresses
Primary practice location
4711 Sunset Blvd
Agape Physicians Care
Lexington, SC 29072-9151
Mailing address
1624 Main Street
Agape Senior Priamary Care, Inc., Dba Agape Physicians
Columbia, SC 29201
Phone (803) 454-0365
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 74724 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07472 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410134400000",
"number": "1316006760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1624 MAIN STREET",
"address_2": "AGAPE SENIOR PRIAMARY CARE, INC., DBA AGAPE PHYSICIANS",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "29201",
"telephone_number": "803-454-0365",
"fax_number": "803-404-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4711 SUNSET BLVD",
"address_2": "AGAPE PHYSICIANS CARE",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290729151",
"telephone_number": "803-356-3609",
"fax_number": "803-451-6135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENNER",
"first_name": "ALLEN",
"middle_name": "RICHARD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2014-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "07472",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "74724",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.