Organization Active NPI

360 Chronic Care Management

  • Nurse Practitioner
  • Aiken, SC
National Provider Identifier
1962260232
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
360 CHRONIC CARE MANAGEMENT
Practice address
35 Varden Dr Ste a-1
Aiken, SC 29803-5275
Phone
(803) 243-1066
Fax
(803) 226-0335
NPI assigned
Mar 11, 2024
Last updated
Jun 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Authorized official

Name
Juanethea Bryantlord, MVHWCNPI 1588201370
Title
Business Owner
Phone
(803) 243-1066

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Registered Nurse 163WC0400X
General Practice Registered Nurse 163WG0000X
Gerontology Registered Nurse 163WG0600X
Nutrition Support Registered Nurse 163WN1003X
Licensed Practical Nurse 164W00000X
Massage Therapist 225700000X
Nurse Practitioner 363L00000X Primary
Adult Health Nurse Practitioner 363LA2200X
Community Health Nurse Practitioner 363LC1500X
Gerontology Nurse Practitioner 363LG0600X
Primary Care Nurse Practitioner 363LP2300X
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X
Health & Wellness Coach 171400000X

Addresses

Primary practice location

35 Varden Dr Ste a-1
Aiken, SC 29803-5275

Mailing address

35 Varden Dr Ste a-1
Aiken, SC 29803-5275
Phone (803) 243-1066

Other practice location 1

41 W Second St
Vanceburg, KY 41179-5441
Phone (803) 610-1847

Other practice location 2

3643 Walton Way Ext Bldg 4A2
Augusta, GA 30909-4507
Phone (803) 610-1847

Other identifiers 1

IdentifierTypeStateIssuer
PG2956MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240730003630 GA Part B Supplier - Clinic/Group Practice 9436694031 Receives reassigned benefits from 1 practitioner
Practice locations: Augusta, GA

National Provider Directory

National Provider Directory

Locations

3643 Walton Way Ext
Bldg 4A2
Augusta, GA 30909
Phone (803) 610-1847

35 Varden Dr
#A1
Aiken, SC 29803
Phone (803) 226-0236

35 Varden Dr
Ste A
Aiken, SC 29803
Phone (803) 226-0236

35 Varden Dr
Ste A1
Aiken, SC 29803
Phone (803) 226-0236

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750723200000",
    "number": "1962260232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 VARDEN DR STE A-1",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298035275",
            "telephone_number": "803-243-1066",
            "fax_number": "803-226-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 VARDEN DR STE A-1",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298035275",
            "telephone_number": "803-243-1066",
            "fax_number": "803-226-0335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 W Second St",
            "address_purpose": "LOCATION",
            "city": "Vanceburg",
            "state": "KY",
            "postal_code": "411795441",
            "country_code": "US",
            "telephone_number": "803-610-1847",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3643 Walton Way Ext Bldg 4A2",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309094507",
            "country_code": "US",
            "telephone_number": "803-610-1847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "360 CHRONIC CARE MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-11",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A",
        "authorized_official_last_name": "BRYANTLORD",
        "authorized_official_first_name": "JUANETHEA",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "803-243-1066",
        "authorized_official_credential": "MVHWC"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WN1003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nutrition Support",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PG2956",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiken, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.