Active NPI
Phillip William Tolman, PA
- Physician Assistant
- Moncks Corner, SC
National Provider Identifier
1700935699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1194
- Practice address
- 511 N Highway 52
Moncks Corner, SC 29461-3132 - Phone
- (843) 761-0936
- Fax
- (843) 761-0938
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 103958 | NC | |
| Physician Assistant | 363A00000X | 1194 | SC | Primary |
Addresses
Primary practice location
511 N Highway 52
Moncks Corner, SC 29461-3132
Mailing address
PO Box 17190
Las Vegas, NV 89114-7190
Phone (702) 560-2889
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0519PA | Medicaid | SC | |
| P00834849 | Other | SC | RAILROAD MEDICARE ID-RSFPN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103958 | NC | MD | Physician Assistant |
| 1194 | SC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Terry D. Johnson, P.a. | Past | Accepting new patients | |
| Linda L. Johnson MD, LTD | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Moncks Corner, SC
- NPI 1467751495
-
- Adult Medicine Physician
- Henderson, NV
- NPI 1376838110
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304985600000",
"number": "1700935699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 17190",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891147190",
"telephone_number": "702-560-2889",
"fax_number": "702-560-2928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 N HIGHWAY 52",
"city": "MONCKS CORNER",
"state": "SC",
"postal_code": "294613132",
"telephone_number": "843-761-0936",
"fax_number": "843-761-0938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOLMAN",
"first_name": "PHILLIP",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2011-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "103958",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "1194",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0519PA",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE ID-RSFPN",
"identifier": "P00834849",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moncks Corner, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.