NPIMap

Individual provider Active NPI

Kathy Bolus, MD

  • Internal Medicine Physician
  • Charleston, SC
National Provider Identifier
1114995669
Registry record updated Mar 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
15226 Issued in SC
Practice address
650 Ellis Oak Dr
Charleston, SC 29412-3090
Phone
(843) 762-5480
Fax
(843) 762-5488
NPI assigned
Mar 10, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 5

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 11

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

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical University of South Carolina College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolina Family Care Inc 81 clinicians

Practice addresses (Care Compare)

490 Martello Dr
Charleston, SC 29412-2638
Phone (843) 762-5480

Hospital & facility affiliations

  • Musc Health at Home, by Bayada- Charleston Home health agency, Charleston, SC, CCN 427004
  • Roper-St. Francis Home Health Home health agency, Charleston, SC, CCN 427042
  • Interim Healthcare Home health agency, North Charleston, SC, CCN 427132
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065
  • Novant Health East Cooper Medical Center Hospital, Mount Pleasant, SC, CCN 420089

Merit-based Incentive Payment System (MIPS)

Final score
93.96 of 100Reported as group
Quality
89.02
Promoting interoperability
100
Improvement activities
40

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.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20040210000962 SC Practitioner - Internal Medicine 8426942541 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15226SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Family Care Inc Internal Medicine CurrentSince Jul 1, 2003 Accepting new patients
Carolina Family Care, Inc CurrentSince Jul 1, 2003 Accepting new patients
Carolina Family Care, Inc Past Accepting new patients

Locations

490 Martello Dr
Charleston, SC 29412
Phone (843) 762-4963

650 Ellis Oak Dr
Charleston, SC 29412
Phone (843) 266-1540

1208 Two Island Ct
Mt Pleasant, SC 29466
Phone (843) 884-6653

Interoperability endpoints

  • Direct secure messaging: kbolus8752@direct.musc.edu

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 15226 SC Primary

Addresses

NPPES NPI Registry

Primary practice location

650 Ellis Oak Dr
Charleston, SC 29412-3090

Mailing address

PO Box 751357
Charlotte, NC 28275-1357
Phone (843) 762-5480

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
152266MedicaidSC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 5, 2008.

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204675200000",
    "number": "1114995669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751357",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751357",
            "telephone_number": "843-762-5480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 ELLIS OAK DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294123090",
            "telephone_number": "843-762-5480",
            "fax_number": "843-762-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLUS",
        "first_name": "KATHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-10",
        "last_updated": "2008-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "15226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152266",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.