NPIMap

Individual provider Active NPI

Heidi Lynn Tatum, PA-C

  • Physician Assistant
  • Summerville, SC
National Provider Identifier
1508811522
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1101 Issued in SC
Practice address
87 Springview LN
Summerville, SC 29485-9077
Phone
(843) 876-7979
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1101 SC Primary

Addresses

Primary practice location

87 Springview LN
Summerville, SC 29485-9077

Mailing address

PO Box 602108
Charlotte, NC 28260-2108
Phone (843) 792-6200

Other identifiers 3

IdentifierTypeStateIssuer
P01173877OtherSCRR-MEDICARE
GP1551OtherSCMEDICAID GROUP
0526PAMedicaidSC

Other names 1

  • Heidi L Bruggeman Former name

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
I20070531000314 SC Practitioner - Physician Assistant 8820196777 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolina Family Care IncGroup PAC ID 4587557731, 81 clinicians

Practice addresses (Care Compare)

1208 Two Island CT
Mount Pleasant, SC 29466-7436
Phone (843) 884-6653

87 Springview LN
Summerville, SC 29485-9077
Phone (843) 876-7979

Hospital & facility affiliations

  • Musc Health at Home, by Bayada- Charleston Home health agency, Charleston, SC, CCN 427004
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Trident Medical Center Hospital, Charleston, SC, CCN 420079

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Family Care CurrentSince Sep 13, 2018 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Nov 20, 2017 Accepting new patients
Palmetto Primary Care Physicians, LLC CurrentSince Nov 20, 2017 Accepting new patients
Roper Saint Francis Physicians Network CurrentSince Feb 6, 2017 Accepting new patients
Roper Saint Francis Physicians Network CurrentSince Feb 6, 2017 Accepting new patients
Carolina Family Care, Inc CurrentSince Sep 13, 2018 Accepting new patients
Carolina Family Care, Inc Past Accepting new patients

Locations

1401 Main St
Bonneau, SC 29431
Phone (843) 825-3404

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

2075 Eagle Landing Blvd
North Charleston, SC 29406
Phone (843) 797-5747

2550 Elms Center Rd
North Charleston, SC 29406
Phone (843) 302-8840

435 N Cedar St
Summerville, SC 29483
Phone (843) 873-1592

87 Springview Ln
Summerville, SC 29485
Phone (843) 876-7979

Interoperability endpoints

  • Direct secure messaging: htatum30633@direct.musc.edu

Organizations & group practices 9

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1508811522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602108",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602108",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 SPRINGVIEW LN",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294859077",
            "telephone_number": "843-876-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "HEIDI",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR-MEDICARE",
            "identifier": "P01173877",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "GP1551",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0526PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEIDI",
            "last_name": "BRUGGEMAN",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Summerville, SC

Sources for this page

Verify at the official NPI Registry.