Individual provider Active NPI

Dominique Rauls

  • Family Nurse Practitioner
  • Shaw AFB, SC
National Provider Identifier
1861265050
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN268515 Issued in GA
Practice address
420 Polifka Dr
Shaw AFB, SC 29152-5100
Phone
(803) 895-6356
NPI assigned
Oct 31, 2023
Last updated
Jan 30, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN268515 GA Primary

Addresses

Primary practice location

420 Polifka Dr
Shaw AFB, SC 29152-5100

Mailing address

420 Polifka Dr
Shaw AFB, SC 29152-5100
Phone (803) 895-6356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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

Enrollment IDStateProvider typePAC IDDetails
I20231121000303 GA Practitioner - Nurse Practitioner 9436507050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rural Urgent Care LLCGroup PAC ID 8820305600, 171 clinicians

Practice addresses (Care Compare)

1408 Tallahassee Hwy
Suite Z
Bainbridge, GA 39819-7900
Phone (229) 400-9033

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Urgent Care LLC CurrentSince Oct 17, 2023 Accepting new patients
Rural Urgent Care LLC CurrentSince Nov 5, 2023 Accepting new patients
Rural Urgent Care LLC CurrentSince Oct 17, 2023 Accepting new patients

Locations

1500 1st Ave N
Unit 3
Birmingham, AL 35203
Phone (205) 545-5088

1408 Tallahassee Hwy
Ste Z
Bainbridge, GA 39819
Phone (229) 400-9033

1028 W Oglethorpe Hwy
Hinesville, GA 31313
Phone (912) 255-4057

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

NPI Registry JSON

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

{
    "created_epoch": "1698710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1861265050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 POLIFKA DR",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "291525100",
            "telephone_number": "803-895-6356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 POLIFKA DR",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "291525100",
            "telephone_number": "803-895-6356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAULS",
        "first_name": "DOMINIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-31",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN268515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shaw AFB, SC

Sources for this page

Verify at the official NPI Registry.