NPIMap

Individual provider Active NPI

Shanda Retta Mae Hofmann, FNP-BC

  • Nurse Practitioner
  • Charleston, SC
National Provider Identifier
1811660822
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
28260 Issued in SC
Practice address
25 Courtenay Dr
Charleston, SC 29425-2866
Phone
(843) 792-3355
NPI assigned
Jul 26, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9965 CT
Nurse Practitioner 363L00000X 28260 SC Primary

Addresses

Primary practice location

25 Courtenay Dr
Charleston, SC 29425-2866

Mailing address

PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200

Other names 1

  • Miss Shanda Retta Mae Gearhart Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211029000571 CT Practitioner - Nurse Practitioner 9335537018 Reassigns benefits to 1 organization
I20241014002303 SC Practitioner - Nurse Practitioner 9335537018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advanced Cardiovascular Specialists PCGroup PAC ID 4880678846, 13 clinicians

Practice addresses (Care Compare)

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

439 Mill Hill Ave
Bridgeport, CT 06610-2866
Phone (203) 334-2100

Hospital & facility affiliations

  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Bridgeport Hospital Hospital, Bridgeport, CT, CCN 070010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9965CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol Nurse Practitioner CurrentSince Sep 20, 2024 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Sep 20, 2024 Accepting new patients
Advanced Cardiovascular Specialists PC CurrentSince Nov 1, 2021 Accepting new patients

Locations

439 Mill Hill Ave
Bridgeport, CT 06610
Phone (203) 334-2100

25 Courtenay Dr
Charleston, SC 29425
Phone (843) 792-1952

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

2060 Sam Rittenberg Blvd
Charleston, SC 29407
Phone (843) 876-0111

8992 University Blvd
North Charleston, SC 29406
Phone (843) 876-5555

5500 Front St
Summerville, SC 29486
Phone (843) 712-1414

Interoperability endpoints

  • Direct secure messaging: shofmann506684@direct.musc.edu

Organizations & group practices 3

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": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1811660822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 COURTENAY DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294252866",
            "telephone_number": "843-792-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOFMANN",
        "first_name": "SHANDA",
        "middle_name": "RETTA MAE",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "9965",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "28260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANDA",
            "last_name": "GEARHART",
            "middle_name": "RETTA MAE",
            "prefix": "MISS",
            "credential": "MILLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.