Thomas David Shelburne III, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5178 Issued in SC

Practice address

610 Columbiana Dr
Columbia, SC 29212-0728

Phone

(803) 902-6568

Fax

(803) 902-6570

NPI assigned

Dec 5, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology of SC PCGroup PAC ID 4284864372, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Advanced Dermatology of SC PC

  • Dermatology Physician
  • Spartanburg, SC
  • NPI 1255754008
  Medicare reassignment Care Compare group
• Camille Mason MD PA

  • MOHS-Micrographic Surgery Physician
  • Abbeville, SC
  • NPI 1942594031
  Medicare reassignment
• Carolina Bone and Joint Clinic

  • Specialist
  • Abbeville, SC
  • NPI 1306999636
  NPD (past)
• Palmetto Dermatology

  • Dermatology Physician
  • West Columbia, SC
  • NPI 1457433278
  NPD (past)

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

{
    "created_epoch": "1701734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1811764467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 COLUMBIANA DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292120728",
            "telephone_number": "803-902-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 COLUMBIANA DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292120728",
            "telephone_number": "803-902-6568",
            "fax_number": "803-902-6570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3574 Sunset Blvd",
            "address_purpose": "LOCATION",
            "city": "West Columbia",
            "state": "SC",
            "postal_code": "291693044",
            "country_code": "US",
            "telephone_number": "803-796-2500",
            "fax_number": "803-796-4378",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHELBURNE",
        "first_name": "THOMAS",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-05",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "5178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacquelynn Tracee Sheffield, RN
• Kaylee Sheffield, PHYSICIAN ASSISTANT
• Morgan Sheffield
• Rhonda Sheffield
• Tammy Shehorn, RBT
• Cynthia Shelby, RBT
• Larry Francis Sheldon, PA-C
• Shelia's Helping Hands LLC
• Jacob Shell, PHARMD
• Gayle Bockman Shellenberg, LMSW

• Physician Assistant in Columbia, SC
• Providers in Columbia, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.