NPIMap

Individual provider Active NPI

Jody K Eblen, ANP

  • Adult Health Nurse Practitioner
  • Charleston, SC
National Provider Identifier
1578876553
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
104130 Issued in SC
Practice address
171 Ashley Ave
Charleston, SC 29425-3133
Phone
(843) 792-1414
NPI assigned
Jul 20, 2010
Last updated
Jan 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 104130 SC Primary

Addresses

Primary practice location

171 Ashley Ave
Charleston, SC 29425-3133

Mailing address

PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200

Other practice location 1

1049B Anna Knapp Blvd
MT Pleasant, SC 29464-3133
Phone (843) 849-8800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110105000303 SC Practitioner - Nurse Practitioner 7911196019 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Medical University of South Carolina College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolina Family Care IncGroup PAC ID 4587557731, 81 clinicians

Practice addresses (Care Compare)

1200 Innovation Way
Mt Pleasant, SC 29466-8414
Phone (843) 876-1454

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.96 of 100Reported as group
Quality
89.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4339SCMDDental Hygienist
104130SCMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol CurrentSince Jul 19, 2021 Accepting new patients
Carolina Family Care, Inc CurrentSince May 1, 2023 Accepting new patients
Carolina Family Care CurrentSince May 1, 2023 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Jul 19, 2021 Accepting new patients
Internal Medical Associates, PA Past Accepting new patients

Locations

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

1113 Park West Blvd
Mt Pleasant, SC 29466
Phone (843) 876-1445

1200 Innovation Way
Mt Pleasant, SC 29466
Phone (843) 876-1445

1208 Two Island Ct
Mt Pleasant, SC 29466
Phone (843) 884-6653

Interoperability endpoints

  • Direct secure messaging: jeblen362532@direct.musc.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1578876553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294253133",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1049B Anna Knapp Blvd",
            "address_purpose": "LOCATION",
            "city": "MT Pleasant",
            "state": "SC",
            "postal_code": "294643133",
            "country_code": "US",
            "telephone_number": "843-849-8800",
            "fax_number": "843-849-8889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBLEN",
        "first_name": "JODY",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "104130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "171 Ashley Ave",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294253133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.