Zachary Andrew Wulbecker

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3497 Issued in SC

Practice address

9200 University Blvd
North Charleston, SC 29406-9121

Phone

(438) 637-4628

NPI assigned

Feb 14, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Zack Andrew Wulbecker Professional name

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• 24 On Physicians of SC, LLC

  • Hospitalist Physician
  • Charleston, SC
  • NPI 1144877655
  Medicare reassignment
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555
  Medicare reassignment

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

{
    "created_epoch": "1297641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1851698674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 118087",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294238087",
            "telephone_number": "843-863-7462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 UNIVERSITY BLVD",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069121",
            "telephone_number": "438-637-4628"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1024 S LeMay Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805243929",
            "country_code": "US",
            "telephone_number": "303-306-7783",
            "fax_number": "303-306-7753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WULBECKER",
        "first_name": "ZACHARY",
        "middle_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-14",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0003686",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "1580",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25779231",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "P01212979",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Laptop",
            "affiliation": "N",
            "endpointDescription": "Laptop",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Academics",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Academics",
            "address_1": "9200 University Blvd",
            "city": "North Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294069121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ZACK",
            "last_name": "WULBECKER",
            "middle_name": "ANDREW",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kyla Wright
• Recaree Wright
• Rochelle T Wright
• Shannon Wright, PHARMD
• Tysheika Wright
• Carolyn C Wysong, R.N
• Xenon Anesthesia of South Carolina LLC
• Xiaomei Xu
• Shyam Yallapragada, MD
• Young Women Network

• Physician Assistant in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.