Thomas C. Kickham, D.O.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

241 Issued in SC

Practice address

200 Booker Dr
Walhalla, SC 29691-2278

Phone

(864) 656-3076

Fax

(843) 985-9562

NPI assigned

Apr 5, 2006

Last updated

Dec 13, 2023By the provider in NPPES

Sex

Male

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 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anmed Health

  dba AnMed

  • Emergency Medicine Physician
  • Anderson, SC
  • NPI 1710918321
  Medicare reassignment NPD
• Clemson University

  • Family Nurse Practitioner
  • Walhalla, SC
  • NPI 1093990707
  Medicare reassignment NPD
• South Carolina Dept of Mental Health Accounting Office

  dba Patrick B Harris Psychiatric Hospital

  • Psychiatric Hospital
  • Anderson, SC
  • NPI 1376595041
  Medicare reassignment NPD
• Anmed Health

  dba AnMed Primary Care - Piedmont

  • Family Medicine Physician
  • Piedmont, SC
  • NPI 1255137832
  NPD
• Clemson University

  • Rural Health Clinic/Center
  • Walhalla, SC
  • NPI 1568345445
  NPD
• Diagnostic Radiology of Anderson, P.a.

  • Diagnostic Radiology Physician
  • Anderson, SC
  • NPI 1922125269
  NPD
• Piedmont Pathology Associates PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Anderson, SC
  • NPI 1235101965
  NPD
• South Carolina Dept of Mental Health Accounting Office

  dba Midlands Crisis Stabilization Center

  • Community/Behavioral Health Agency
  • Columbia, SC
  • NPI 1083421994
  NPD

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1669434437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N FANT ST",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296215708",
            "telephone_number": "864-512-1335",
            "fax_number": "843-985-9562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BOOKER DR",
            "city": "WALHALLA",
            "state": "SC",
            "postal_code": "296912278",
            "telephone_number": "864-656-3076",
            "fax_number": "843-985-9562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 N Fant St",
            "address_purpose": "LOCATION",
            "city": "Anderson",
            "state": "SC",
            "postal_code": "296215708",
            "country_code": "US",
            "telephone_number": "864-512-1335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KICKHAM",
        "first_name": "THOMAS",
        "middle_name": "C.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "241",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "SC",
            "license": "241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000925306A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89066G1",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002419",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dale A Hullander, PH.D
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• Maria Kraayeveld
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• Eric Martin Lander, DC

• General Practice Physician in Walhalla, SC
• Providers in Walhalla, SC by specialty
• General Practice Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.