NPIMap

Individual provider Active NPI

Dominique Samarane Bultsma, MD

  • Internal Medicine Physician
  • Johns Island, SC
National Provider Identifier
1033733704
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
90584 Issued in SC
Practice address
345 Freshfields Dr Ste J101
Johns Island, SC 29455-5443
Phone
(843) 768-4800
Fax
(843) 606-8039
NPI assigned
May 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 90584 SC Primary
Internal Medicine Physician 207R00000X LL84222 SC

Addresses

Primary practice location

345 Freshfields Dr Ste J101
Johns Island, SC 29455-5443

Mailing address

PO Box 751649
Charlotte, NC 28275-1649
Phone (888) 472-0043

Other identifiers 1

IdentifierTypeStateIssuer
905846MedicaidSC

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
I20231107000516 SC Practitioner - Internal MedicinePractitioner - Hospitalist 8729407895 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Wayne State University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
24 On Physicians of SC LLCGroup PAC ID 5890127344, 136 clinicians
Roper Saint Francis Physicians NetworkGroup PAC ID 5193874824, 530 clinicians

Practice addresses (Care Compare)

1565 Sam Rittenberg Blvd
Suite 100
Charleston, SC 29407-4128
Phone (843) 412-9012

316 Calhoun St
Charleston, SC 29401-1113
Phone (843) 724-2901

345 Freshfields Dr
J101
Johns Island, SC 29455-5443
Phone (843) 768-4800

Hospital & facility affiliations

  • Roper Hospital Hospital, Charleston, SC, CCN 420087
  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065
  • Roper St Francis Hospital-Berkeley Inc Hospital, Summerville, SC, CCN 420110
  • Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104

Merit-based Incentive Payment System (MIPS)

Final score
84.09 of 100Reported as group
Quality
79.17
Improvement activities
40
Cost
69.71

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
90584SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Roper Saint Francis Physicians Network CurrentSince Apr 6, 2026 Accepting new patients
Roper Saint Francis Physicians Network CurrentSince Apr 6, 2026 Accepting new patients
Dominique Bultsma MD PC Internal Medicine CurrentSince Jul 1, 2025 Accepting new patients
24 On Physicians of SC, LLC CurrentSince Sep 6, 2023 Accepting new patients
Roper Hospital, Inc Past Accepting new patients

Locations

1565 Sam Rittenberg Blvd
Ste 100
Charleston, SC 29407
Phone (843) 412-9012

1565 Sam Rittenberg Blvd
Charleston, SC 29407
Phone (843) 571-0744

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

345 Freshfields Dr
#J101
Johns Island, SC 29455
Phone (843) 768-4800

345 Freshfields Dr
Ste J101
Johns Island, SC 29455
Phone (843) 768-4800

2075 Eagle Landing Blvd
North Charleston, SC 29406
Phone (843) 797-5747

Organizations & group practices 11

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 4

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": "1590710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1033733704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751649",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751649",
            "telephone_number": "888-472-0043",
            "fax_number": "843-724-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 FRESHFIELDS DR STE J101",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294555443",
            "telephone_number": "843-768-4800",
            "fax_number": "843-606-8039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULTSMA",
        "first_name": "DOMINIQUE",
        "middle_name": "SAMARANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-29",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "90584",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL84222",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "905846",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Island, SC

Sources for this page

Verify at the official NPI Registry.