NPIMap

Individual provider Active NPI

Judson Chase Woollen, MD

  • Vascular Surgery Physician
  • Greenwood, SC
National Provider Identifier
1790213833
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
92051 Issued in SC
Practice address
160 Academy Ave
Greenwood, SC 29646-3808
Phone
(864) 223-8090
NPI assigned
Jun 2, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 41051 SC
Vascular Surgery Physician 2086S0129X 92051 SC Primary

Addresses

Primary practice location

160 Academy Ave
Greenwood, SC 29646-3808

Mailing address

701 Grove Rd FL 3
Greenville, SC 29605-4210
Phone (864) 455-1435

Other practice location 1

701 Grove Rd Fl 3
Greenville, SC 29605-4210
Phone (864) 455-1435

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
I20240913000991 SC Practitioner - General Surgery 3375814817 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of South Carolina School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Practice addresses (Care Compare)

155 Ridge Medical Plaza Rd
Edgefield, SC 29824-4531
Phone (803) 637-3146

160 Academy Ave
Greenwood, SC 29646-3808
Phone (864) 223-8090

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41051SCMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Aug 1, 2024 Accepting new patients
Self Medical Group Surgery CurrentSince Aug 1, 2024 Accepting new patients
Self Regional Healthcare Partners Surgery CurrentSince Feb 23, 2025 Accepting new patients
Self Regional Healthcare Partners CurrentSince Feb 23, 2025 Accepting new patients
Self Regional Healthcare Partners Current Accepting new patients
Self Medical Group Surgery Current Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients

Locations

75 Remittance Dr
Dept 6764
Chicago, IL 60675

155 Ridge Medical Plaza Rd
Edgefield, SC 29824
Phone (803) 637-3146

300 Ridge Medical Plaza Rd
Edgefield, SC 29824
Phone (803) 637-3174

160 Academy Ave
Greenwood, SC 29646
Phone (864) 223-7809

104 Wells Ave
Greenwood, SC 29646

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Interoperability endpoints

  • Direct secure messaging: jwoollen169781@selfregional.direct-ci.net

Organizations & group practices 7

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 8

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": "1496361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1790213833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 GROVE RD FL 3",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054210",
            "telephone_number": "864-455-1435",
            "fax_number": "864-455-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 ACADEMY AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463808",
            "telephone_number": "864-223-8090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Grove Rd Fl 3",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296054210",
            "country_code": "US",
            "telephone_number": "864-455-1435",
            "fax_number": "864-455-1320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOOLLEN",
        "first_name": "JUDSON",
        "middle_name": "CHASE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-02",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "41051",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "SC",
            "license": "92051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.