Individual provider Active NPI

Julia M. Wren, MD

  • Internal Medicine Physician
  • Conway, SC
National Provider Identifier
1679668792
Registry record updated Feb 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
TL32293 Issued in SC
Practice address
100 Professional Park Dr
Conway, SC 29526-9260
Phone
(843) 234-8260
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 48695 WI
Pediatrics Physician 208000000X 48695 WI
Pediatrics Physician 208000000X TL32293 SC
Internal Medicine Physician 207R00000X TL32293 SC Primary

Addresses

Primary practice location

100 Professional Park Dr
Conway, SC 29526-9260

Mailing address

100 Professional Park Dr
Conway, SC 29526-9260
Phone (843) 234-8260

Other identifiers 1

IdentifierTypeStateIssuer
322939MedicaidSC

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100708000327 SC Practitioner - Internal MedicinePractitioner - Pediatric Medicine 7416005004 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TL32293SCMDPediatrics Physician
48695WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Careteam Plus, Inc. Internal Medicine CurrentSince Jan 1, 2020 Accepting new patients
Careteam Plus, Inc. CurrentSince Jan 1, 2020 Accepting new patients
Careteam Plus, Inc. Past Accepting new patients

Locations

100 Professional Park Dr
Conway, SC 29526
Phone (843) 234-0005

Organizations & group practices 3

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581033600000",
    "number": "1679668792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269260",
            "telephone_number": "843-234-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269260",
            "telephone_number": "843-234-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WREN",
        "first_name": "JULIA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "48695",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "48695",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "TL32293",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "TL32293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "322939",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.