Individual provider Active NPI

Matthew Wrench Sr., AGPCNP-C

  • Gerontology Nurse Practitioner
  • Fuquay Varina, NC
National Provider Identifier
1689347619
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
5014776 Issued in NC
Practice address
2400 N Main St Ste 210
Fuquay Varina, NC 27526-8573
Phone
(919) 235-6501
Fax
(919) 341-3043
NPI assigned
Jul 27, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 5014776 NC
Gerontology Nurse Practitioner 363LG0600X 5014776 NC Primary

Addresses

Primary practice location

2400 N Main St Ste 210
Fuquay Varina, NC 27526-8573

Mailing address

124 Teal Lake Dr
Holly Springs, NC 27540-8887
Phone (919) 369-2439

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210812000360 NC Practitioner - Nurse Practitioner 7911301924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of North Carolina at Chapel Hill School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7270

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5014776NCMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Raleigh Cardiology Associates, PA Current Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Sep 12, 2021 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Sep 12, 2021 Accepting new patients
Wakemed Specialists Group, LLC Current Accepting new patients

Locations

210 Ashville Ave
Cary, NC 27518
Phone (919) 235-6460

2400 N Main St
Ste 210
Fuquay Varina, NC 27526
Phone (919) 235-6501

3000 New Bern Ave
Ste 1200
Raleigh, NC 27610
Phone (919) 231-6132

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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": "1627344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1689347619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 TEAL LAKE DR",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275408887",
            "telephone_number": "919-369-2439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N MAIN ST STE 210",
            "city": "FUQUAY VARINA",
            "state": "NC",
            "postal_code": "275268573",
            "telephone_number": "919-235-6501",
            "fax_number": "919-341-3043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRENCH",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "AGPCNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-27",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5014776",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5014776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fuquay Varina, NC

Sources for this page

Verify at the official NPI Registry.