NPIMap

Individual provider Active NPI

David Dwight Goltra Jr., M.D.

  • Neuroradiology Physician
  • Mount Pleasant, SC
National Provider Identifier
1477640647
Registry record updated Oct 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
14764 Issued in SC
Practice address
582 Lone Tree Drive
582 Long Point Rd
Mt Pleasant, SC 29464
Phone
(843) 352-0674
Fax
(843) 971-8832
NPI assigned
Oct 6, 2006
Last updated
Oct 15, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 14764 SC Primary

Addresses

Primary practice location

582 Lone Tree Drive
582 Long Point Rd
Mt Pleasant, SC 29464

Mailing address

582 Lone Tree Drive
582 Long Point Road
Florence, SC 29501-0523
Phone (843) 352-0674

Other identifiers 1

IdentifierTypeStateIssuer
147647MedicaidSC

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
I20040719001443 SC Practitioner - Diagnostic Radiology 0042299307 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Ohio State University College of Medicine, 1985
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

410 University Pkwy
Suite 1000
Aiken, SC 29801-6800
Phone (803) 644-4264

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.33 of 100Reported as group
Quality
86.06
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
79.48 of 100Reported as group
Quality
56.49
Promoting interoperability
100
Improvement activities
40
Cost
75.11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston ENT Associates, LLC CurrentSince Jan 1, 2007 Accepting new patients
Charleston ENT Associates, LLC CurrentSince Jan 1, 2007 Accepting new patients
Augusta Orthopedic & Sports Medicine Specialists PC CurrentSince Oct 1, 2021 Accepting new patients
Nathan H. Brandon, MD, LLC Past Accepting new patients
Charleston Neuroscience Institute LLC PastSince Feb 1, 2009 Accepting new patients
Charleston Neurosciences Institute Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Coastal Plains Physician Associates Past Accepting new patients
Disc Radiologists PA Past Accepting new patients
Carolina Imaging Consultants P a Neuroradiology PastSince Nov 18, 2004 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients
Aef Management Group Past Accepting new patients

Locations

410 University Pkwy
Ste 1000
Aiken, SC 29801
Phone (803) 644-4264

1849 Savage Rd
Charleston, SC 29407
Phone (843) 576-2600

2295 Henry Tecklenburg Dr
Charleston, SC 29414

Interoperability endpoints

  • Direct secure messaging: david.goltra.p1@direct.entap.nextgenshare.com

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

Hospital & facility affiliations 10

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192406400000",
    "number": "1477640647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "582 LONE TREE DRIVE",
            "address_2": "582 LONG POINT ROAD",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295010523",
            "telephone_number": "843-352-0674",
            "fax_number": "843-971-8832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "582 LONE TREE DRIVE",
            "address_2": "582 LONG POINT RD",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "29464",
            "telephone_number": "843-352-0674",
            "fax_number": "843-971-8832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLTRA",
        "first_name": "DAVID",
        "middle_name": "DWIGHT",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "SC",
            "license": "14764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147647",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

Verify at the official NPI Registry.