Clarence William Wimberly Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5740 Issued in SC

Practice address

435 N Cedar St
Summerville, SC 29483-6407

Phone

(843) 873-1592

Fax

(843) 871-2936

NPI assigned

Nov 4, 2005

Reactivated

Apr 17, 2019

Last updated

Apr 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Palmetto Primary Care Physicians, LLC

  dba PPCP Canterbury House

  • Family Medicine Physician
  • Charleston, SC
  • NPI 1073234928
  Medicare reassignment NPD
• Palmetto Primary Care Physicians, LLC

  dba Summerville Family Practice Associates

  • Family Medicine Physician
  • Summerville, SC
  • NPI 1144630716
  NPD
• Palmetto Primary Care Physicians, LLC

  • Family Medicine Physician
  • Summerville, SC
  • NPI 1366123739
  NPD
• Covenant Counseling of South Carolina

  • Professional Counselor
  • Summerville, SC
  • NPI 1073732822
  NPD (past)

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1932190139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SIGMA DRIVE",
            "address_2": "SUITE 100",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294867722",
            "telephone_number": "843-873-1592",
            "fax_number": "843-871-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 N CEDAR ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294836407",
            "telephone_number": "843-873-1592",
            "fax_number": "843-871-2936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMBERLY",
        "first_name": "CLARENCE",
        "middle_name": "WILLIAM",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2019-04-17",
        "deactivation_date": "2019-03-29",
        "reactivation_date": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "5740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "057404",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01396493",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Diana Wilson-Horney, DPM
• Rachel L Wilson-Johnson
• Esther Spiegle Wilson, MD
• Lucretia D. Wilson, PMHNP-BC
• Selena Wilson, LPC
• Jonathan Polk Wimer, D.M.D
• Kristina Colizzi Windom
• Ashley Wing, FNP-BC
• Jennifer Marie Wingfield, PHARMD
• Seth Winkler, M.D.

• Family Medicine Physician in Summerville, SC
• Providers in Summerville, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; 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.