NPIMap

Individual provider Active NPI

Dale Lullo, AGACNP

  • Acute Care Nurse Practitioner
  • Orangeburg, SC
National Provider Identifier
1245720101
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
21933 Issued in SC
Practice address
3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone
(843) 431-2000
NPI assigned
May 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 21933 SC
Acute Care Nurse Practitioner 363LA2100X 21933 SC Primary

Addresses

Primary practice location

3000 Saint Matthews Rd
Orangeburg, SC 29118

Mailing address

PO Box 23321
New York, NY 10087-0332
Phone (803) 533-2200

Other practice location 1

22725 Highway 76 E
Clinton, SC 29325-7527
Phone (864) 833-9100

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidSC

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181114003340 SC Practitioner - Nurse Practitioner 6103170949 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone (803) 395-3400

Hospital & facility affiliations

  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

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
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Regional Medical Center of Orangeburg and Calhoun Counties Current Accepting new patients
Sound Physicians of South Carolina, LLC CurrentSince Dec 22, 2018 Accepting new patients
Cogent Healthcare of Georgia PC Nurse Practitioner CurrentSince Nov 5, 2018 Accepting new patients
Musc Community Physicians CurrentSince Oct 17, 2023 Accepting new patients
Musc Community Physicians CurrentSince Oct 17, 2023 Accepting new patients
The Regional Medical Center of Orangeburg and Calhoun Counties CurrentSince Oct 1, 2018 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties CurrentSince Oct 1, 2018 Accepting new patients
Medical University Hospital Authority Past Accepting new patients

Locations

302 University Pkwy
Aiken, SC 29801
Phone (803) 279-3940

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

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

Interoperability endpoints

  • Direct secure messaging: dlullo447620@direct.musc.edu
  • FHIR API: https://fhir-myrecord.cerner.com/r4/0fba742b-eec1-4103-87e5-edbdf1fe1e30/

Organizations & group practices 8

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 6

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": "1526428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1245720101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23321",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100870332",
            "telephone_number": "803-533-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 SAINT MATTHEWS RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29118",
            "telephone_number": "843-431-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22725 Highway 76 E",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "SC",
            "postal_code": "293257527",
            "country_code": "US",
            "telephone_number": "864-833-9100",
            "fax_number": "864-833-9458",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LULLO",
        "first_name": "DALE",
        "name_prefix": "Ms.",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-16",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "21933",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "SC",
            "license": "21933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "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": "3000 Saint Matthews Rd",
            "city": "Orangeburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

Verify at the official NPI Registry.