Kelley Hodge Bostic, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

21427 Issued in SC

Practice address

701 Medical Park Dr Ste 301
Hartsville, SC 29550-4779

Phone

(843) 383-5978

Fax

(843) 383-5977

NPI assigned

Oct 31, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Carolina School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prisma Health University Medical GroupGroup PAC ID 8325950983, 2,467 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Prisma Health Tuomey Hospital Hospital, Sumter, SC, CCN 420070

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Prisma Health University Medical Group

  • Family Medicine Physician
  • Greenville, SC
  • NPI 1295763217
  Medicare reassignment Care Compare group NPD
• Prisma Health Medical Group-Midlands

  • Multi-Specialty Clinic/Center
  • Columbia, SC
  • NPI 1275988321
  Medicare reassignment NPD
• Prisma Health Medical Group-Midlands

  dba PH Dentistry

  • Durable Medical Equipment & Medical Supplies
  • Columbia, SC
  • NPI 1881469856
  NPD
• Prisma Health University Medical Group

  dba Parkside OB-GYN

  • Gynecology Physician
  • Greer, SC
  • NPI 1003619313
  NPD
• Prisma Health Medical Group-Midlands

  dba PH Cardiology

  • Interventional Cardiology Physician
  • Columbia, SC
  • NPI 1003307166

  Nurse Practitioner

  NPD (past)

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

• Prisma Health-Midlands

  dba Prisma Health Tuomey Hosptial

  • General Acute Care Hospital
  • Sumter, SC
  • NPI 1326043548
  Care Compare affiliation

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

{
    "created_epoch": "1509408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1396257325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MEDICAL PARK DR STE 301",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295504779",
            "telephone_number": "843-383-5978",
            "fax_number": "843-383-5977"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 N Washington St",
            "address_purpose": "LOCATION",
            "city": "Sumter",
            "state": "SC",
            "postal_code": "291504920",
            "country_code": "US",
            "telephone_number": "803-774-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSTIC",
        "first_name": "KELLEY",
        "middle_name": "HODGE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-31",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "21427",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "21427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP4882",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbostic289151@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kbostic289151@direct.ghs.myhfn.org",
            "address_1": "701 Medical Park Dr Ste 301",
            "city": "Hartsville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Black Creek Medical Consultants, LLC
• Thomas Blackmon
• Karen Blackwell-Boyd
• Eric Le Minh Duc Bonno, MD
• Rena Boone
• Linda Bove, NURSE
• Charles Edwin Boyd Jr.
• Jocelyn Boyer, DEEDEE
• Miller Joseph Pierce Braddock
• Shareese Brady

• Family Nurse Practitioner in Hartsville, SC
• Providers in Hartsville, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.