Individual provider Active NPI

Jerry Allen Wedincamp Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Shelby, NC
National Provider Identifier
1700978590
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
146165 Issued in NC
Practice address
201 E Grover St
Shelby, NC 28150-3917
Phone
(704) 487-3812
NPI assigned
Sep 29, 2006
Last updated
Apr 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 146165 NC Primary

Addresses

Primary practice location

201 E Grover St
Shelby, NC 28150-3917

Mailing address

4400 Golf Acres Drive
Suite a
Charlotte, NC 28208-5906
Phone (704) 512-6428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070313000387 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 6709989742 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3100 Spring Forest Rd
Suite 130
Raleigh, NC 27616-2880
Phone (919) 873-9533

4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone (919) 873-9533

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
The Charlotte-Mecklenburg Hospital Authority Nurse Anesthetist, Certified Registered Current Accepting new patients
Cleveland County Healthcare System Current Accepting new patients
American Anesthesiology of North Carolina, PLLC Nurse Anesthetist, Certified Registered CurrentSince Feb 11, 2021 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2015 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
CHS Anesthesia Services Group Inc CurrentSince Sep 1, 2017 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Jan 1, 2015 Accepting new patients
Gaston Anesthesia Associates, P.a. Past Accepting new patients
Gaston Anesthesia Associates, P.a. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

14215 Ballantyne Corporate Pl
Ste 210
Charlotte, NC 28277
Phone (704) 316-2650

706 W King St
Kings Mtn, NC 28086
Phone (704) 730-5108

3100 Spring Forest Rd
Ste 130
Raleigh, NC 27616
Phone (919) 882-0705

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

612 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

201 E Grover St
Shelby, NC 28150
Phone (704) 487-3000

Organizations & group practices 10

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 1

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": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1700978590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 GOLF ACRES DRIVE",
            "address_2": "SUITE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085906",
            "telephone_number": "704-512-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E GROVER ST",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "281503917",
            "telephone_number": "704-487-3812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDINCAMP",
        "first_name": "JERRY",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "146165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.