DR. THOMAS A UPSHAW M.D.
NPI 1306002142
Psychiatry & Neurology - Psychiatry in Mount Pleasant, SC
NPI Status: Active since July 31, 2008
Contact Information
728 S SHELMORE BLVD STE 103
MOUNT PLEASANT, SC
ZIP 29464
Phone: (843) 972-0262
Fax: (843) 972-0263
- Individual
- Male
- Years of Experience 32
- Psychiatry & Neurology
- Psychiatry
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
- CLIA Number: 42D2039577
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-11-2028
About THOMAS UPSHAW
This page provides the complete NPI Profile along with additional information for Thomas Upshaw, a provider established in Mount Pleasant, South Carolina with a medical specialization in Psychiatry & Neurology, focusing in psychiatry and more than 32 years of experience. He graduated from Emory University School Of Medicine in 1994. The healthcare provider is registered in the NPI registry with number 1306002142 assigned on July 2008. The practitioner's primary taxonomy code is 2084P0800X with license number 18101 (SC). The provider is registered as an individual and his NPI record was last updated 3 years ago.
- NPI
- 1306002142
- Provider Name
- DR. THOMAS A UPSHAW M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 728 S SHELMORE BLVD STE 103 MOUNT PLEASANT, SC 29464
- Location Phone
- (843) 972-0262
- Location Fax
- (843) 972-0263
- Mailing Address
- 728 S SHELMORE BLVD STE 103 MOUNT PLEASANT, SC 29464
- Mailing Phone
- (843) 972-0262
- Mailing Fax
- (843) 972-0263
- Medical School Name
- EMORY UNIVERSITY SCHOOL OF MEDICINE
- Graduation Year
- 1994
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 07-31-2008
- Last Update Date
- 09-18-2023
- Code Navigator
A psychiatrist like Thomas Upshaw are primary mental health physicians diagnose and treat mental illnesses through psychotherapy, psychoanalysis, hospitalization and medication. Psychiatrist help patients find solutions through changes in their behavioral patterns, explorations of experiences, group and family therapy.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychiatry & Neurology Psychiatry
- Taxonomy Code
- 2084P0800X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 18101
- License State
- SC
- Taxonomy Description
- A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Cooper Bronze 1 - HMO
- Blue Cooper Bronze 2 - HMO
- Blue Cooper Gold 1 - HMO
- Blue Cooper Silver 1 - HMO
- Blue Cooper Silver 2 - HMO
- Blue Cooper Silver 2 + Adult Vision - HMO
- Blue Cooper Standard Expanded Bronze - HMO
- Blue Cooper Standard Gold - HMO
- Blue Cooper Standard Silver - HMO
- Blue Direction Bronze 1 - POS
- Blue Direction Silver 1 - POS
- Blue Direction Silver 1 + Adult Vision - POS
- Blue Direction Silver 2 - POS
- Blue Direction Standard Expanded Bronze - POS
- Blue Direction Standard Gold - POS
- Blue Direction Standard Silver - POS
- Blue VirtuConnect Bronze 1 - EPO
- Blue VirtuConnect Gold 1 - EPO
- Blue VirtuConnect Silver 1 - EPO
- BlueEssentials Bronze 4 - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 181010 | MEDICAID (05) | SC |
Medicare Participation & PECOS Enrollment Status
Thomas Upshaw is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Thomas Upshaw is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 4082694328
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20040726000681
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Initial nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes
Psychotherapy with evaluation and management visit, 30 minutes
Psychotherapy with evaluation and management visit, 45 minutes
Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
This service was performed 222 times for 42 patientsThis is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 136 times for 20 patientsAn initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.
This service was performed 49 times for 49 patientsPsychotherapy with evaluation and management is a 30-minute session where a mental health professional talks with you about your concerns and feelings. They assess your mental health, provide support, and manage your treatment plan to help improve your well-being.
This service was performed 252 times for 51 patientsPsychotherapy with evaluation and management is a 45-minute session where a healthcare provider discusses your mental and emotional health. They assess your current state, manage any issues, and help you develop coping strategies. This service aims to improve your overall well-being.
This service was performed 104 times for 21 patientsA follow-up nursing facility visit is a routine check-up that typically lasts about 35 minutes. During this visit, your health status is evaluated, any changes in your condition are noted, and necessary adjustments to your care plan are made. It's an essential part of maintaining your health.
This service was performed 78 times for 32 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $40.96 for a new patient copayment and $16.78 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 29464 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99205
- Average New Patient Price $163.84
- Minimum New Patient Price $53.57
- Maximum New Patient Price $163.84
- Average New Patient Copayment $40.96
- Minimum New Patient Copayment $13.39
- Maximum New Patient Copayment $40.96
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $67.12
- Minimum Established Patient Price $16.96
- Maximum Established Patient Price $133.52
- Average Established Patient Copayment $16.78
- Minimum Established Patient Copayment $4.24
- Maximum Established Patient Copayment $33.38
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Adult Major Depressive Disorder (MDD): Suicide Risk Assessment | 90% | 158 |
| Percentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified | ||
| Annual registration in the Prescription Drug Monitoring Program | Yes | N/A |
| Annual registration by eligible clinician or group in the prescription drug monitoring program of the state where they practice. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and groups must participate for a minimum of 6 months. | ||
| Consultation of the Prescription Drug Monitoring Program | Yes | N/A |
| Clinicians would attest to reviewing the patients’ history of controlled substance prescription using state prescription drug monitoring program (PDMP) data prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription lasting longer than 3 days. For the transition year, clinicians would attest to 60 percent review of applicable patient’s history. For the Quality Payment Program Year 2 and future years, clinicians would attest to 75 percent review of applicable patient’s history performance. | ||
| Depression screening | Yes | N/A |
| Depression screening and follow-up plan: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including depression screening and follow-up plan (refer to NQF #0418) for patients with co-occurring conditions of behavioral or mental health conditions. | ||
| Documentation of Current Medications in the Medical Record | 93% | 1431 |
| Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| e-Prescribing | 100% | 2357 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Falls: Screening for Future Fall Risk | 92% | 89 |
| Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period | ||
| Medication Reconciliation | 98% | 1343 |
| The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. | ||
| Patient-Specific Education | 88% | 297 |
| The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 45% | 271 |
| Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Preventive Care and Screening: Screening for Depression and Follow-Up Plan | 93% | 69 |
| Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen | ||
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 33% | 64 |
| Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user | ||
| Provide Patient Access | 83% | 297 |
| At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. | ||
| Secure Messaging | 5% | 297 |
| For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| Use of High-Risk Medications in the Elderly | 5% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 77 |
| Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication | ||
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 42D2039577
- Facility Type
- Physician Office
- Certificate Effective Date
- April 12, 2026
- Certificate Expiration Date
- April 11, 2028
- Laboratory Director
- THOMAS UPSHAW
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Thomas Upshaw to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1306002142, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 48. The final step is to find the difference between that total and the next multiple of ten (50 - 48 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 48 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
MT PLEASANT, SC 29464
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1306002142, enumerated as an "individual" on July 31, 2008.
The provider is located at 728 S SHELMORE BLVD STE 103 MOUNT PLEASANT, SC 29464 and the phone number is (843) 972-0262.
Psychiatry & Neurology with taxonomy code 2084P0800X and a focus in Psychiatry.
The provider might be accepting Accepts: BlueCross BlueShield of South Carolina, Medicare. Please consult your insurance carrier or call the provider to verify.
