Individual provider Active NPI

Thomas H Douglas, M.D.

  • Urology Physician
  • Rock Hill, SC
National Provider Identifier
1336213883
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
21281 Issued in SC
Practice address
1780 Medical Park Dr
Rock Hill, SC 29732-1194
Phone
(803) 327-1116
Fax
(803) 327-6872
NPI assigned
Nov 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 99-00476 NC
Urology Physician 208800000X 0101045853 VA
Urology Physician 208800000X 21281 SC Primary

Addresses

Primary practice location

1780 Medical Park Dr
Rock Hill, SC 29732-1194

Mailing address

9735 Kincey Ave
Suite 201
Huntersville, NC 28078-9118
Phone (704) 414-2870

Other identifiers 8

IdentifierTypeStateIssuer
8912374MedicaidNC
0007034011OtherSCAETNA
136HXOtherNCBCBS OF NC
212816MedicaidSC
1905793OtherSCUNITED HEALTHCARE
867215OtherSCGREAT WEST
90023OtherSCMEDCOST
279873OtherSCMAMSI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090316000151 NC Practitioner - Urology 7012072184 Reassigns benefits to 2 organizations
I20091231000227 SC Practitioner - Urology 7012072184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Virginia School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Urology Partners PLLCGroup PAC ID 8921280587, 37 clinicians

Practice addresses (Care Compare)

1698 Hwy 160 W
Suite 220
Fort Mill, SC 29708-8034
Phone (803) 578-7600

1780 Medical Park Dr
Rock Hill, SC 29732-1194
Phone (803) 327-1116

9735 Kincey Ave
Suite 201
Huntersville, NC 28078-9118
Phone (704) 414-2870

Hospital & facility affiliations

  • Piedmont Medical Center Hospital, Rock Hill, SC, CCN 420002
  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Carolinas Rehabilitation Inpatient rehabilitation facility, Charlotte, NC, CCN 343026

Merit-based Incentive Payment System (MIPS)

Final score
97.45 of 100Reported as group
Promoting interoperability
97
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection15
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
99-00476NCMDUrology Physician
21281SCMDUrology Physician
0101045853VAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stone Institute of the Carolinas LLC Urology CurrentSince Oct 19, 2014 Accepting new patients
Carolina Urology Partners PLLC Urology CurrentSince Mar 1, 2011 Accepting new patients
Carolina Urology Center, PA Urology Past Accepting new patients

Locations

12610 N Community House Rd
Ste 100
Charlotte, NC 28277
Phone (704) 610-3220

9735 Kincey Ave
Ste 302
Huntersville, NC 28078
Phone (704) 414-2870

9735 Kincey Ave
Ste 201
Huntersville, NC 28078
Phone (704) 414-2865

1698 Highway 160 W
Ste 220
Fort Mill, SC 29708
Phone (803) 578-7600

1077 W Meeting St
#A
Lancaster, SC 29720
Phone (803) 285-1337

1780 Medical Park Dr
Rock Hill, SC 29732
Phone (803) 327-1116

Interoperability endpoints

  • Direct secure messaging: thomas.douglas.p1@direct.cup.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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 8

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": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1336213883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9735 KINCEY AVE",
            "address_2": "SUITE 201",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280789118",
            "telephone_number": "704-414-2870",
            "fax_number": "704-414-2860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 MEDICAL PARK DR",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321194",
            "telephone_number": "803-327-1116",
            "fax_number": "803-327-6872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "THOMAS",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NC",
            "license": "99-00476",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "VA",
            "license": "0101045853",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SC",
            "license": "21281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8912374",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007034011",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "136HX",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "212816",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1905793",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT WEST",
            "identifier": "867215",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "90023",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "279873",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

Verify at the official NPI Registry.