Individual provider Active NPI

Caroline Bolarinwa Sam, MD

  • Psychiatry Physician
  • Charleston, SC
National Provider Identifier
1104440205
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MMD.84327 Issued in SC
Practice address
2100 Charlie Hall Blvd
Charleston, SC 29414-5832
Phone
(843) 852-4100
Fax
(305) 891-4228
NPI assigned
Jun 4, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MMD.84327 SC Primary

Addresses

Primary practice location

2100 Charlie Hall Blvd
Charleston, SC 29414-5832

Mailing address

169 Ashley Avenue
MSC 333
Charleston, SC 29425-8905

Other practice location 1

171 Ashley Ave
Charleston, SC 29425-8905
Phone (843) 792-1414

Other practice location 2

169 Ashley Avenue
MSC 333
Charleston, SC 29425-8905
Phone (843) 792-0192

Other identifiers 1

IdentifierTypeStateIssuer
1760596480MedicaidSC

Other names 1

  • Caroline Bolanle Bolarinwa Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230720004190 SC Practitioner - Psychiatry 1951720903 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
79.02 of 100Reported as group
Quality
62.41
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MMD.84327SCMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lowcountry Wellness Center LLC CurrentSince Jul 1, 2023 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Aug 1, 2024 Accepting new patients
University Medical Associates of the Medical University of South Carol Psychiatry CurrentSince Aug 1, 2024 Accepting new patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients

Locations

1483 Tobias Gadson Blvd
Ste 201
Charleston, SC 29407
Phone (843) 745-5153

169 Ashley Ave
#333
Charleston, SC 29425
Phone (843) 792-2575

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

2100 Charlie Hall Blvd
Charleston, SC 29414
Phone (843) 212-8968

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1104440205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVENUE",
            "address_2": "MSC 333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CHARLIE HALL BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145832",
            "telephone_number": "843-852-4100",
            "fax_number": "305-891-4228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "171 Ashley Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258905",
            "country_code": "US",
            "telephone_number": "843-792-1414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "169 Ashley Avenue",
            "address_2": "MSC 333",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258905",
            "country_code": "US",
            "telephone_number": "843-792-0192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAM",
        "first_name": "CAROLINE",
        "middle_name": "BOLARINWA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-04",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "MMD.84327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760596480",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "171 Ashley Ave",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294258905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CAROLINE",
            "last_name": "BOLARINWA",
            "middle_name": "BOLANLE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.