Jade Hazel Pack

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

29972 Issued in SC

Practice address

107 Sunset Dr
Manning, SC 29102-2904

Phone

(803) 435-4447

NPI assigned

Dec 10, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarendon Health and Wellness CenterGroup PAC ID 9931472669, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLeod Health Clarendon Hospital, Manning, SC, CCN 420109

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16484/brand/1/csg/1/fhir/r4

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.

• Clarendon Health and Wellness Center

  • Family Medicine Physician
  • Manning, SC
  • NPI 1689194060
  Medicare reassignment Care Compare group NPD
• Carolina Family Practice

  • Family Medicine Physician
  • Manning, SC
  • NPI 1891976619
  NPD (past)

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

• McLeod Health Clarendon

  • Rural Acute Care Hospital
  • Manning, SC
  • NPI 1205284411
  Care Compare affiliation

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

{
    "created_epoch": "1733788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1992511216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 ZOAR CHURCH RD",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291539180",
            "telephone_number": "803-464-8697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 SUNSET DR",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291022904",
            "telephone_number": "803-435-4447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "JADE",
        "middle_name": "HAZEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-10",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "263902",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "29972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabrina Gail O'Brien, M.D.
• Ohio Valley Physicians Inc
• Cheryl Otto
• Michael A Ouzts, RPH
• Robert T Ouzts, PHARMD
• Madison Victoria Packer
• Palmetto Women'S Healthcare PA
• Natcher L. Parker
• Pee Dee Emergency Medical Associates
• Joshua Taylor Perry, DO

• Family Nurse Practitioner in Manning, SC
• Providers in Manning, 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 Apr 3, 2025; 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.