NPIMap

Individual provider Active NPI

Matthew C Wallen, MD

  • Emergency Medicine Physician
  • Moncks Corner, SC
National Provider Identifier
1962442921
Registry record updated Apr 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
023720 Issued in SC
Practice address
401 North Live Oak Drive
Moncks Corner, SC 29461
Phone
(843) 761-8721
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 023720 SC Primary

Addresses

Primary practice location

401 North Live Oak Drive
Moncks Corner, SC 29461

Mailing address

PO Box 11450
Westminster, CA 92685
Phone (800) 509-8102

Other identifiers 1

IdentifierTypeStateIssuer
237201MedicaidSC

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
I20031110000038 SC Practitioner - Emergency Medicine 8921911694 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical University of South Carolina College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Physicians Emergency Medicine of South Carolina LLCGroup PAC ID 2163702739, 48 clinicians
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone (803) 553-2200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.46 of 100Reported as group
Quality
47.5
Promoting interoperability
100
Improvement activities
40
Cost
83.42

Merit-based Incentive Payment System (MIPS)

Final score
88.55 of 100Reported as group
Quality
85
Promoting interoperability
100
Improvement activities
40
Cost
76.83

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
023720SCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Jan 1, 2026 Accepting new patients
Sound Physicians Emergency Medicine of South Carolina LLC Emergency Medicine CurrentSince Nov 6, 2019 Accepting new patients
Georgetown Memorial Hospital CurrentSince Apr 16, 2016 Accepting new patients
Waccamaw Community Hospital CurrentSince Apr 16, 2016 Accepting new patients
Georgetown Memorial Hospital CurrentSince Apr 16, 2016 Accepting new patients
Musc Community Physicians CurrentSince Jan 1, 2026 Accepting new patients
Jesup Emergency Services, LLC Emergency Medicine Past Accepting new patients
Apollomd Group Services, LLC Emergency Medicine Past Accepting new patients

Locations

302 University Pkwy
Aiken, SC 29801
Phone (803) 279-3940

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

2435 Forest Dr
Columbia, SC 29204
Phone (770) 874-6859

1524 Barnwell Hwy
Denmark, SC 29042
Phone (803) 395-3352

606 Black River Rd
Georgetown, SC 29440
Phone (843) 527-7000

2000 Hospital Dr
Mt Pleasant, SC 29464
Phone (803) 533-2200

4070 Highway 17
Murrells Inlt, SC 29576
Phone (843) 357-5100

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

Interoperability endpoints

  • Direct secure messaging: mwallen446732@direct.musc.edu

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240272000000",
    "number": "1962442921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11450",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "92685",
            "telephone_number": "800-509-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 NORTH LIVE OAK DRIVE",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "29461",
            "telephone_number": "843-761-8721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "MATTHEW",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2009-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "023720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "237201",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

Verify at the official NPI Registry.