Active NPI
Jasen Conrad, LMSW
- Social Worker
- Charleston, SC
National Provider Identifier
1376971341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 2100 Charlie Hall Blvd
Charleston, SC 29414-5832 - Phone
- (843) 852-4100
- NPI assigned
- Oct 29, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
2100 Charlie Hall Blvd
Charleston, SC 29414-5832
Mailing address
2100 Charlie Hall Blvd
Charleston, SC 29414-5832
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760596480 | 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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Welllife Network Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Case Management Agency
- Elmont, NY
- NPI 1508012816
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682640000000",
"number": "1376971341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 CHARLIE HALL BLVD",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294145832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 CHARLIE HALL BLVD",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294145832",
"telephone_number": "843-852-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONRAD",
"first_name": "JASEN",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-29",
"last_updated": "2023-04-28",
"certification_date": "2023-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.