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DOMINIQUE SAMARANE BULTSMA MD
NPI 1033733704
Internal Medicine in Johns Island, SC

Active since May 29, 2020PECOS EnrolledAccepts Medicare Assignment
73.24/100
CMS Quality Rating
345 FRESHFIELDS DR STE J101, JOHNS ISLAND, SC 29455(843) 768-4800(843) 606-8039 Get Directions Write a Review

NPPES record last updated: February 23, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 10, 2025, May 29, 2020 (2 updates tracked since 2020).

About Dominique Samarane Bultsma Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DOMINIQUE SAMARANE BULTSMA MD (NPI 1033733704) is an individual internal medicine provider in Johns Island, South Carolina, licensed in South Carolina (90584) and active in the NPI registry since May 2020. She is enrolled in Medicare PECOS, is affiliated with Bon Secours-st Francis Xavier Hospital, and is a graduate of Wayne State University School Of Medicine (2020).

NPPES Registry Identity

NPI1033733704
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameDOMINIQUE SAMARANE BULTSMACredential: MD
Location Address345 FRESHFIELDS DR STE J101Johns Island, SC 29455-5443
Mailing AddressPo Box 751649Charlotte, NC 28275-1649 · (888) 472-0043 · Fax (843) 724-2440
Phone(843) 768-4800
Fax(843) 606-8039
Sole ProprietorNo
Medical School CMSWayne State University School Of MedicineGraduated 2020
Enumeration DateMay 29, 2020
Last NPPES UpdateFebruary 23, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 23, 2026
✔ NPI 1033733704 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Licenses✔ Licensed in SC · 90584✔ Licensed in SC · LL84222
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
345 FRESHFIELDS DR STE J101, Johns Island, SC 29455
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Other Identifiers 1

Medicaid905846SC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include First Choice Next.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dominique Samarane Bultsma Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729407895
PECOS Enrollment IDI20231107000516
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
310 services125 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
157 services85 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
79 services79 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
34 services34 patients
Hospital discharge day management, 30 minutes or less 99238
Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.
30 services30 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
15 services15 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Bon Secours-St Francis Xavier Hospital

Acute Care Hospitals · Charleston, SC
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number420065
Location2095 Henry Tecklenburg DriveCharleston, SC 29414 · Charleston County
Emergency services Birthing friendly

Roper Hospital

Acute Care Hospitals · Charleston, SC
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number420087
Location316 Calhoun StCharleston, SC 29401 · Charleston County
Emergency services

Mount Pleasant Hospital

Acute Care Hospitals · Mount Pleasant, SC
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number420104
Location3510 Highway 17 North Suite 140Mount Pleasant, SC 29466 · Charleston County
Emergency services

Roper St Francis Hospital-Berkeley Inc

Acute Care Hospitals · Summerville, SC
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number420110
Location300 Callen BlvdSummerville, SC 29486 · Dorchester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29455 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$124.04 typical visit price
range $53.57 – $163.84
Typical copayment $31.01 (range $13.39 – $40.96)
Most-billed visit code 99204
Established Patient
$95.12 typical visit price
range $16.96 – $133.52
Typical copayment $23.78 (range $4.24 – $33.38)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

73.24/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality73.04
Cost59.51

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SARAH E RELYEA-LOGAN MD
Family Medicine
345 FRESHFIELDS DR STE J101
JOHNS ISLAND, SC 29455
Charleston County (843) 768-4800
STACY ANN MESSERSMITH FNP
Nurse Practitioner (Family)
345 FRESHFIELDS DR STE J101
JOHNS ISLAND, SC 29455
Charleston County (843) 768-4800
DR. SASHA MILLEMAN PEREZ M.D.
Family Medicine
345 FRESHFIELDS DR STE J101
JOHNS ISLAND, SC 29455
Charleston County (843) 768-4800
MR. ARTHUR DUNCAN WELLS OLIPHANT PA
Physician Assistant
345 FRESHFIELDS DR STE J101
JOHNS ISLAND, SC 29455
Charleston County (843) 768-4800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dominique Bultsma's NPI number?

The NPI number for Dominique Bultsma is 1033733704. It was assigned to this individual provider in the NPPES registry on May 29, 2020.

Where is Dominique Bultsma located?

Dominique Bultsma practices at 345 Freshfields Dr Ste J101, Johns Island, SC 29455. The listed phone number is (843) 768-4800.

What is Dominique Bultsma's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Dominique Bultsma enrolled in Medicare?

Yes. Dominique Bultsma is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Dominique Bultsma accept?

Health plans from First Choice Next list Dominique Bultsma as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Dominique Bultsma affiliated with any hospitals?

According to CMS data, Dominique Bultsma is affiliated with Bon Secours-St Francis Xavier Hospital, Roper Hospital, Mount Pleasant Hospital and Roper St Francis Hospital-Berkeley Inc.

When was this NPI record last updated?

The NPPES record for Dominique Bultsma was last updated on February 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.