NPIMap

Individual provider Active NPI

Caitlan Walsh Tucker, PA

  • Physician Assistant
  • Greenville, SC
National Provider Identifier
1538718812
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3348 Issued in SC
Practice address
25 Creekview CT
Greenville, SC 29615-4800
Phone
(864) 522-6300
Fax
(864) 522-6305
NPI assigned
Sep 9, 2019
Last updated
Aug 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X SC
Physician Assistant 363A00000X 3348 SC Primary

Addresses

Primary practice location

25 Creekview CT
Greenville, SC 29615-4800

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

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
I20200402003271 SC Practitioner - Physician Assistant 6305274390 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Musc Affiliate PhysiciansGroup PAC ID 6305241027, 48 clinicians

Practice addresses (Care Compare)

145 E Poinsett St
Greer, SC 29651-3405
Phone (864) 272-0388

2 Bella Grove Dr
Greenville, SC 29607-3459
Phone (864) 603-5600

312 Harrison Bridge Rd
Simpsonville, SC 29680-7133
Phone (864) 757-5500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3348SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Aug 2, 2021 Accepting new patients
Prisma Health University Medical Group CurrentSince Aug 2, 2021 Accepting new patients
Musc Affiliate Physicians CurrentSince Dec 7, 2021 Accepting new patients
University Medical Associates Past Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

2 Bella Grove Dr
Greenville, SC 29607
Phone (864) 603-5600

25 Creekview Ct
Greenville, SC 29615
Phone (864) 297-7900

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

145 E Poinsett St
Greer, SC 29651
Phone 86460356003222

312 Harrison Bridge Rd
Ste B
Simpsonville, SC 29680
Phone (864) 603-5600

Interoperability endpoints

  • Direct secure messaging: caitlan.tucker@bmpdbpc.eclinicaldirectplus.com

Organizations & group practices 5

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.

Hospital & facility affiliations 59

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

View all 59

NPI Registry JSON

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

{
    "created_epoch": "1567987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1538718812",
    "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",
            "fax_number": "864-458-8841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 CREEKVIEW CT",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154800",
            "telephone_number": "864-522-6300",
            "fax_number": "864-522-6305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "CAITLAN",
        "middle_name": "WALSH",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-09",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.