Individual provider Active NPI

Jason A Wimberly, M.D.

  • Anesthesiology Physician
  • Charleston, SC
National Provider Identifier
1962445510
Registry record updated Jun 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
25741 Issued in SC
Practice address
9263 Medical Plaza Dr
Ste E
Charleston, SC 29406-7112
Phone
(843) 572-1228
Fax
(877) 561-7564
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 25741 SC Primary

Addresses

Primary practice location

9263 Medical Plaza Dr
Ste E
Charleston, SC 29406-7112

Mailing address

9263 Medical Plaza Dr
Ste E
Charleston, SC 29406-7112
Phone (843) 572-1228

Other identifiers 1

IdentifierTypeStateIssuer
257411MedicaidSC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20060925000576 SC Practitioner - Anesthesiology 8224033279 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical University of South Carolina College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Anesthesia Associates LLCGroup PAC ID 9032022744, 16 clinicians
Anesthesia Services of CharlestonGroup PAC ID 5496757692, 11 clinicians
Trident Anesthesia Group LLCGroup PAC ID 5294631545, 121 clinicians

Practice addresses (Care Compare)

130 Edge St
Summerville, SC 29486-3002
Phone (843) 764-0992

1849 Savage Rd
Charleston, SC 29407-4726
Phone (843) 576-2600

9330 Medical Plaza Dr
Charleston, SC 29406-9104
Phone (843) 797-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25741SCMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Palmetto Digestive Disease PA CurrentSince Dec 1, 2017 Accepting new patients
Palmetto Anesthesia of Charleston, LLC Anesthesiology CurrentSince Jan 1, 2007 Accepting new patients
Trident Anesthesia Group, LLC Anesthesiology CurrentSince Aug 1, 2006 Accepting new patients
Anesthesia Services of Charleston Anesthesiology CurrentSince Jan 1, 2026 Accepting new patients
Coastal Anesthesia Associates, LLC Anesthesiology CurrentSince Sep 24, 2014 Accepting new patients

Locations

2073 Charlie Hall Blvd
Charleston, SC 29414
Phone (843) 571-0643

1849 Savage Rd
Charleston, SC 29407
Phone (843) 576-2600

1962 Charlie Hall Blvd
Charleston, SC 29414
Phone (803) 722-8000

423 Barony St
Moncks Corner, SC 29461

9330 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 554-6366

9263 Medical Plaza Dr
Ste E
North Charleston, SC 29406
Phone (843) 572-1228

9313 Medical Plaza Dr
Ste 102
North Charleston, SC 29406
Phone (843) 572-1228

130 Edge St
Summerville, SC 29486
Phone (843) 628-5816

Organizations & group practices 5

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 1

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338508800000",
    "number": "1962445510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9263 MEDICAL PLAZA DR",
            "address_2": "STE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294067112",
            "telephone_number": "843-572-1228",
            "fax_number": "877-561-7564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9263 MEDICAL PLAZA DR",
            "address_2": "STE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294067112",
            "telephone_number": "843-572-1228",
            "fax_number": "877-561-7564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMBERLY",
        "first_name": "JASON",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2012-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "25741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257411",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.