Jacquelyn B Waldron, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R40094 Issued in SC

Practice address

22580 Highway 76 E
Suite 100
Laurens, SC 29360-8439

Phone

(864) 833-5986

Fax

(864) 833-0599

NPI assigned

Jun 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Nurse Practitioner

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Self Regional HealthcareGroup PAC ID 4082527742, 159 clinicians

Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Self Regional Healthcare Hospital, Greenwood, SC, CCN 420071
• Prisma Health Laurens County Hospital Hospital, Clinton, SC, CCN 420038

Merit-based Incentive Payment System (MIPS)

Final score

94.7 of 100Reported as apm

Quality

89.4

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwaldron127338@selfregional.direct-ci.net

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.

• Self Medical Group

  • Surgery Physician
  • Greenwood, SC
  • NPI 1982836847
  Medicare reassignment Care Compare group NPD
• Self Regional Healthcare

  • Family Medicine Physician
  • Greenwood, SC
  • NPI 1326067703
  Medicare reassignment Care Compare group NPD
• Self Medical Group

  • Surgery Physician
  • Greenwood, SC
  • NPI 1457685570
  NPD
• Self Medical Group

  • Diagnostic Radiology Physician
  • Greenwood, SC
  • NPI 1659839694
  NPD
• Self Regional Healthcare

  • Family Medicine Physician
  • Laurens, SC
  • NPI 1114726460
  NPD
• Self Regional Healthcare

  • Neurology Physician
  • Greenwood, SC
  • NPI 1285502559
  NPD
• Self Medical Group

  • Gastroenterology Physician
  • Greenwood, SC
  • NPI 1841047560
  NPD (past)
• The Family Healthcare Center

  • Family Medicine Physician
  • Clinton, SC
  • NPI 1457399396
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prisma Health-Upstate

  • General Acute Care Hospital
  • Clinton, SC
  • NPI 1245786367
  Care Compare affiliation
• Self Regional Healthcare

  • Pain Medicine (Anesthesiology) Physician
  • Greenwood, SC
  • NPI 1013867498

  Hospital

  Care Compare affiliation
• Self Regional Healthcare

  • General Acute Care Hospital
  • Greenwood, SC
  • NPI 1023046612
  Care Compare affiliation
• Self Regional Healthcare

  • General Acute Care Hospital
  • Greenwood, SC
  • NPI 1407887003
  Care Compare affiliation
• Self Regional Healthcare

  • Pain Medicine (Anesthesiology) Physician
  • Clinton, SC
  • NPI 1720938103

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1982647525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22580 HIGHWAY 76 E",
            "address_2": "SUITE 100",
            "city": "LAURENS",
            "state": "SC",
            "postal_code": "293608439",
            "telephone_number": "864-833-5986",
            "fax_number": "864-833-0599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22580 HIGHWAY 76 E",
            "address_2": "SUITE 100",
            "city": "LAURENS",
            "state": "SC",
            "postal_code": "293608439",
            "telephone_number": "864-833-5986",
            "fax_number": "864-833-0599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDRON",
        "first_name": "JACQUELYN",
        "middle_name": "B",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "R40094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP0249",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwaldron127338@selfregional.direct-ci.net",
            "affiliation": "N",
            "address_1": "22580 Highway 76 E",
            "address_2": "Suite 100",
            "city": "Laurens",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293608439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alecia Van Strien
• Thinh Vo
• Miriam Elizabeth Wagner, MS CCC-SLP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co
• Desiree Walker, PHARMD
• Marlo Walker
• Stanley G Walsh, MD

• Family Nurse Practitioner in Laurens, SC
• Providers in Laurens, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.