MR. JEROME MIRANDA WICKER
NPI 1811430408
Counselor in Greenville, SC

Q: What is Jerome Wicker's NPI number?

The NPI number for Jerome Wicker is 1811430408. It was assigned to this individual provider in the NPPES registry on November 30, 2016.

Q: What is Jerome Wicker's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Q: When was this NPI record last updated?

The NPPES record for Jerome Wicker was last updated on November 30, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 30, 2016PECOS EnrolledAccepts Medicare Assignment

124 MALLARD ST, GREENVILLE, SC 29601(864) 241-1040(864) 241-8189 Get Directions Write a Review

NPPES record last updated: November 30, 2016. Verified against the NPPES registry weekly; last sync: October 04, 2026.

On this page

About Mr. Jerome Miranda Wicker NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JEROME MIRANDA WICKER (NPI 1811430408) is an individual counselor in Greenville, South Carolina and active in the NPI registry since November 2016. He is enrolled in Medicare PECOS and is a graduate of Other (2001).

NPPES Registry Identity

NPI1811430408

Entity TypeIndividualMale

Primary Taxonomy101Y00000X

Provider Legal NameMR. JEROME MIRANDA WICKER

Location Address124 MALLARD STGreenville, SC 29601-4046

Mailing Address124 Mallard StGreenville, SC 29601-4046 · (864) 241-1040 · Fax (864) 241-8189

Phone(864) 241-1040

Fax(864) 241-8189

Sole ProprietorYes

Medical School CMSOtherGraduated 2001

Enumeration DateNovember 30, 2016

✔ NPI 1811430408 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

124 MALLARD ST, Greenville, SC 29601

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Other Identifiers 2

Medicare PIN3333SC

Medicaid301100SC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include First Choice Next, Molina Healthcare, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Jerome Miranda Wicker is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4789020702

PECOS Enrollment IDI20240313001807

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NYTEAR MCCLAIN

Registered Nurse