NPIMap

Individual provider Active NPI

Charlotte Wallace, M.D.

  • Diagnostic Radiology Physician
  • Charleston, SC
National Provider Identifier
1831540178
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
39581 Issued in SC
Practice address
96 Jonathan Lucas St
Charleston, SC 29425-6672
Phone
(843) 792-2300
NPI assigned
Jun 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X LL39581 SC
Diagnostic Radiology Physician 2085R0202X 39581 SC Primary

Addresses

Primary practice location

96 Jonathan Lucas St
Charleston, SC 29425-6672

Mailing address

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

Other practice location 1

1210 W Faris Rd
Greenville, SC 29605-4444
Phone (864) 522-1800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.musc.edu Direct

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
I20210629001062 SC Practitioner - Diagnostic Radiology 2062709256 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians
Smi Imaging LLCGroup PAC ID 3476696220, 380 clinicians
Georgetown RadiologyGroup PAC ID 1153405360, 7 clinicians

Practice addresses (Care Compare)

3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone (803) 395-3400

51 Cotillion CT
Georgetown, SC 29440-7052
Phone (480) 306-6949

606 Black River Rd
Georgetown, SC 29440-3304
Phone (843) 527-7441

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.05 of 100Reported as group
Quality
85
Improvement activities
40
Cost
76.83

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
39581SCMDDiagnostic Radiology Physician
LL39581SCMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Georgetown Radiology Diagnostic Radiology Current Accepting new patients
Tidelands Health Market Common LLC CurrentSince Aug 23, 2022 Accepting new patients
Musc Community Physicians Diagnostic Radiology CurrentSince Dec 28, 2025 Accepting new patients
Musc Community Physicians CurrentSince Dec 28, 2025 Accepting new patients
Georgetown Radiology Diagnostic Radiology CurrentSince Jul 1, 2022 Accepting new patients
Smi Imaging, LLC Diagnostic Radiology CurrentSince Sep 15, 2025 Accepting new patients
University Medical Associates of the Medical University of South Carol Diagnostic Radiology CurrentSince Jun 10, 2021 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Jun 10, 2021 Accepting new patients
Tidelands and Medquest Joint Venture, LLC CurrentSince Aug 23, 2022 Accepting new patients

Locations

20414 N 27th Ave
Ste 150
Phoenix, AZ 85027
Phone (623) 234-2520

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

96 Jonathan Lucas St
Charleston, SC 29425
Phone (843) 792-3072

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

606 Black River Rd
Georgetown, SC 29440
Phone (843) 527-7000

4070 Highway 17
Murrells Inlt, SC 29576
Phone (843) 357-5100

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

Organizations & group practices 9

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 10

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": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1831540178",
    "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": "96 JONATHAN LUCAS ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294256672",
            "telephone_number": "843-792-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1210 W Faris Rd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296054444",
            "country_code": "US",
            "telephone_number": "864-522-1800",
            "fax_number": "864-522-1806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHARLOTTE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "SC",
            "license": "LL39581",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "39581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.musc.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "96 Jonathan Lucas St",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294256672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.