Jack Messenger Condrey Jr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2785 Issued in SC

Practice address

5306 Parkshire Way
Charleston, SC 29418-2000

Phone

(843) 552-1600

Fax

(843) 552-0049

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

Yes

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 SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Archdale Family Dentistry

  • Dentist
  • North Charleston, SC
  • NPI 1245574995
  NPD (past) Authorized official
• Archdale Family Dentistry Associates, LLC

  • General Practice Dentistry
  • North Charleston, SC
  • NPI 1609316454
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1407875289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5306 PARKSHIRE WAY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294182000",
            "telephone_number": "843-552-1600",
            "fax_number": "843-552-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5306 PARKSHIRE WAY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294182000",
            "telephone_number": "843-552-1600",
            "fax_number": "843-552-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDREY",
        "first_name": "JACK",
        "middle_name": "MESSENGER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "2785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "992785",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Christine Conard, RDN
• Concentra Health Services, Inc.
• Gianina C Concepcion
• Concierge Pediatrics LLC (Paragon Pediatrics)
• Doreen Yarbrough Condon, M.D.
• Jackson Messenger Condrey III, MD
• Anthony J Congeni, M.D.
• Hannah Leigh Conley, MD
• Gary Elizabeth Conly, DNP, FNP
• Andrew Randall Conn, MD

• General Practice Dentistry in Charleston, SC
• Providers in Charleston, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.