NPIMap

Individual provider Active NPI

Tallulah Holmstrom, MD

  • Internal Medicine Physician
  • Lugoff, SC
National Provider Identifier
1053363887
Registry record updated Feb 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
16660 Issued in SC
Practice address
710 Dewitt Dr
Lugoff, SC 29078-9069
Phone
(803) 438-7566
Fax
(803) 438-4371
NPI assigned
May 17, 2006
Last updated
Feb 24, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 16660 SC Primary

Addresses

Primary practice location

710 Dewitt Dr
Lugoff, SC 29078-9069

Mailing address

PO Box 1259
Sentinel Health Partners PA
Camden, SC 29021-1259
Phone (803) 713-8350

Other identifiers 3

IdentifierTypeStateIssuer
64417OtherMEDCOST
166607MedicaidSC
110143766OtherSCRAILROAD MEDICARE PIN

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
I20100324000314 SC Practitioner - Internal Medicine 8729113170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical University of South Carolina College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

2689 Hwy 1 S
Elgin, SC 29045-9055
Phone (803) 438-7698

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16660SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Aug 1, 2021 Accepting new patients
Musc Community Physicians Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients
Sentinel Health Partners, PA Past Accepting new patients
Sentinel Health Partners, PA Past Accepting new patients
Medical University Hospital Authority PastSince Aug 1, 2021 Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1111 Mill St
Camden, SC 29020
Phone (803) 425-1330

1315 Roberts St
Camden, SC 29020
Phone (803) 432-4311

1344 Haile St
Camden, SC 29020
Phone (803) 254-3376

2001 Laurel St
Ste 300
Columbia, SC 29204
Phone (803) 254-2786

2689 Highway 1 S
Elgin, SC 29045
Phone (803) 438-7698

1165 Highway 1 S
Ste 500
Lugoff, SC 29078
Phone (803) 438-0825

710 Dewitt Dr
Lugoff, SC 29078
Phone (803) 233-1730

Interoperability endpoints

  • Direct secure messaging: tholmstrom379693@direct.musc.edu

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Musc Health Hospice KershawLugoff, SC, CCN 421519 Hospice W-2 Managing Employee (100%) Aug 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330041600000",
    "number": "1053363887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1259",
            "address_2": "SENTINEL HEALTH PARTNERS PA",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290211259",
            "telephone_number": "803-713-8350",
            "fax_number": "803-713-8433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 DEWITT DR",
            "city": "LUGOFF",
            "state": "SC",
            "postal_code": "290789069",
            "telephone_number": "803-438-7566",
            "fax_number": "803-438-4371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMSTROM",
        "first_name": "TALLULAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "16660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "64417",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166607",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "110143766",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lugoff, SC

Sources for this page

Verify at the official NPI Registry.